Is ASTRO's recommendation to avoid whole brain radiotherapy following SRS for limited brain metastases practical for patients treated in the community setting?

Agree, YES! But, can I elaborate? :)

No evidence has ever indicated any benefit more than local/elsewhere brain control for WBRT. The addition of WBRT to surgery didn't change overall survival, and enough retrospective data indicates cognitive side effects. Patchell's trial used 50.4 Gy in 1.8 Gy fra...

I agree in priniciple SRS is best whenever possible. However the treatment is for palliation.

1. Coming back for retreatment is not good palliation.

2. Is all of the memory decline due to WBRT or the combination? 67% with SRS alone is in itself significant.

3. The median survival in both groups is i...

To me, the decision about SRS with/without whole brain radiation still has to be discussed with the patient. I think most patients want just SRS (and it is reasonable) but I am not really sure that they understand why that is a reasonable decision. And for some patients WBRT is the right choice for ...

Choosing Wisely states: "Don’t routinely add adjuvant whole brain radiation therapy to stereotactic radiosurgery for limited brain metastases".

I don't think Choosing Wisely made a blanket policy at all, and I don't think anyone is suggesting that. The question above was "Is the recommendation pract...

YES

I agree with Laurie. I always discuss the pro and cons of WBRT +/- SRS and SRS alone. Sunnybrook Odette Cancer Centre and my previous center (UH Cleveland Med Ctr/ Case Western Reserve U) completed a small patient preference study which was presented at ESTRO. Most pts picked SRS. Hopefully, it will...