Critical appraisal:Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al 2004 2
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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:
331
Includes an economic evaluation
no
Evidence ratings
Level of evidence
II
Risk of bias
Low risk of bias | Comments: Large RCT, central randomisation, stratified for prognostic factors,19% in SRS arm did not receive SRS but ITT analysis, adequate FU |
Size of effect
1 | Reason for decision: RCT of WBRT (37.5/15) +/- SRS boost of 18-24Gy in patients with up to 3 brain metastases. No difference in survival or intracranial progression or neurological deaths overall. SRS group had sig better PS and reduced steroid use following treatment. In subgroup analysis, patients with solitary inoperable met had improvement in survival from median 4.9m to 6.5m. |
Relevance of evidence
1 | Additional comments: Endpoint was survival. Also looked at local control, patient performance status, steroid use and mental state - all patient relevant outcomes.Approx 2/3rd of patients had lung primary. |
Result of appraisal
Completed by
- 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
Section below only relevant for Cancer Council Project Officer