Thank you for the opportunity to reply to the letter of Drs. McWilliams and Maurer. We were truly perplexed by the presentation of the meningeal metastases in the reported patient. Lacking convincing evidence of central nervous system metastatic disease or bony erosion of the skull, we were loath to apply chemotherapy, which might have aggravated his clinical course and would have been of doubtful efficacy in any event. Additional radiation therapy was felt to be inadvisable because, in the opinion of our radiotherapists, the patient had been treated originally with a dose that closely approached the tolerance of the brain stem.