Critical appraisal:Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, et al 2006

Critical Appraisal

Article being appraised

Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 2006 Jun 7;295(21):2483-91 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16757720.

Applicable clinical question

What is the role of stereotactic radiosurgery in the treatment of brain metastases?

Key Facts

Study Design

randomised controlled trial

Number of Patients:

132

Includes an economic evaluation

no

Evidence ratings

Level of evidence

II

Risk of bias

Moderate risk of bias

Comments: Medium sized RCT, Central randomisation, ITT analysis, Good FU, Trial closed early, insufficient power to detect smaller differences in survival

Size of effect

1	Reason for decision: RCT of SRS (18-25GY) +/- WBRT (30/10). WBRT reduced brain recurrence and improved brain control but did not affect median survival, PS or neurological function.

Relevance of evidence

1	Additional comments: Endpoints of survival, function, recurrence, cause of death. Relevant to adjuvant WBRT question rather than value of SRS question.

Result of appraisal

Included