Letter to the editor regarding the article “Stereotactic radiosurgery versus whole-brain radiotherapy in patients with 4–10 brain metastases: A nonrandomized controlled trial” by Bodensohn et al

I read the work of Bodensohn et al [ [1] Chang E.L. et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009; 10: 1037-1044 Abstract Full Text Full Text PDF PubMed Scopus (1934) Google Scholar ]. with thankful interest. In a situation where the life expectancy of metastatic cancer patients is increasing, attempts to maintain the quality of life are essential. In the authors' study, the median survival of the stereotactic radiosurgery (SRS) group was 3.3 months longer than that of the control group, with borderline significance (p = 0.074). In the multivariate analysis, the hazard ratio was 0.38 (p = 0.001), showing a benefit of SRS. In randomized studies treating small number of brain metastases, whole brain radiotherapy (WBRT) added to SRS did not improve survival, and might induce cognitive function loss [ 2 Bodensohn R. et al. Stereotactic radiosurgery versus whole-brain radiotherapy in patients with 4–10 brain metastases: A nonrandomized controlled trial. Radiother Oncol. 2023; 186109744 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 3 Brown P.D. et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: A randomized clinical trial. J Am Med Assoc. 2016; 316: 401-409 Crossref PubMed Google Scholar , 4 Aoyama H. et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. J Am Med Assoc. 2006; 295: 2483-2491 Crossref PubMed Scopus (1834) Google Scholar ]. In a randomized study comparing SRS and WBRT groups for 4–15 brain metastases, reported by Li et al [ [5] Li J. et al. Stereotactic radiosurgery versus whole-brain radiation therapy for patients with 4–15 brain metastases: a phase III randomized controlled trial. Int J Radiat Oncol Biol Phys. 2020; 108: S21-S22 Abstract Full Text Full Text PDF Google Scholar ] in the 2020 ASTRO meeting, no difference noted in survival, but SRS group had the better neurocognitive function. Given the scarcity of studies for the large number of brain metastasis, the authors' study can be encouraging for those who support the wider use of SRS. Response to the letters to the editor of S. Benkhaled et al. and C.H. Rim regarding the article “Stereotactic radiosurgery versus whole-brain radiotherapy in patients with 4–10 brain metastases: A nonrandomized controlled trial” by Bodensohn et al.Radiotherapy and OncologyVol. 189PreviewWe would like to express our sincere gratitude to our colleagues C.H. Rim and S. Benkhaled et al. for their valuable and insightful comments to our paper via their letters [1–3]. Full-Text PDF