Stereotactic radiosurgery for patients with brain metastases – Authors' reply

Abstract

We thank Filippo Alongi and colleagues for their interest in our work. 1 Yamamoto M Serizawa T Shuto T et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol. 2014; 15: 387-395 Summary Full Text Full Text PDF PubMed Scopus (820) Google Scholar We are aware that there has been a debate for more than 20 years as to whether it is meaningful to calculate survival after stereotactic radiosurgery in a cohort, because about 90% of patients died in our study due to extracerebral disease progression after stereotactic radiosurgery for brain metastases. However, overall survival is still the most certain endpoint, as reported by Korn and colleagues, 2 Korn EL Freidlin B Abrams JS Overall survival as the outcome for randomized clinical trials with effective subsequent therapies. J Clin Oncol. 2011; 29: 2439-2442 Crossref PubMed Scopus (93) Google Scholar and the majority of previous studies have used overall survival to assess results after stereotactic radiosurgery. Nevertheless, as Alongi and colleagues point out, overall survival alone cannot be regarded as sufficient. Thus, we analysed several secondary endpoints in our study to compensate for this weakness. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational studyOur results suggest that stereotactic radiosurgery without WBRT in patients with five to ten brain metastases is non-inferior to that in patients with two to four brain metastases. Considering the minimal invasiveness of stereotactic radiosurgery and the fewer side-effects than with WBRT, stereotactic radiosurgery might be a suitable alternative for patients with up to ten brain metastases. Full-Text PDF Stereotactic radiosurgery for patients with brain metastasesWe read with interest the Article by Masaaki Yamamoto and colleagues1 about the use of stereotactic radiosurgery in patients with one to ten brain metastases. Their prospective, observational study was well designed and they enrolled many patients (n=1194); nevertheless, their findings raise several relevant questions about stereotactic radiosurgery and whole-brain radiotherapy. We have several concerns about the study. First, overall survival is not an appropriate primary endpoint to assess the effectiveness of a local therapy such as brain stereotactic radiosurgery. Full-Text PDF Stereotactic radiosurgery for patients with brain metastasesWe congratulate Masaaki Yamamoto and colleagues1 for their important contribution to the management of patients with brain metastases, which showed that overall survival in patients with five to ten brain lesions was not inferior to those with two to four lesions when treated with stereotactic radiotherapy. We believe, however, that caution is needed when interpreting these results and we have several concerns. Full-Text PDF