Critical appraisal:Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al 2004

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Critical Appraisal

Article being appraised

Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004 May 22;363(9422):1665-72 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15158627.


Applicable clinical question

Key Facts

Study Design

randomised controlled trial

Number of Patients:

333


Includes an economic evaluation

no

Evidence ratings

Level of evidence

II

Risk of bias
Low risk of bias Comments: Large RTOG RCT.Central randomisation. Good FU. ITT analysis.


Size of effect
1 Reason for decision: RCT of WBRT (37.5/15) +/- SRS boost for patients with 1-3 mets. No differences in mean survival, TTP or neurological death rates. Patients with SRS had improved PS and reduced steroid use at 6m. Patients with solitary met had improved mean survival with SRS (6.5vs4.9m)
Relevance of evidence
1 Additional comments: Endpoints of survival, also response, local control, performance status.
Result of appraisal

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Completed by

Associate Professor Shalini Vinod MBBS MD FRANZCR


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Article
Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004 May 22;363(9422):1665-72 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15158627.
Assigned to
User:Shalini.vinod
Topic area
Guidelines:Lung cancer/Treatment/Non-small-cell stage IV inoperable
Clinical question
Form
Form:Critical appraisal


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