# JROSG 99-1 (Aoyama): stereotactic radiosurgery with or without whole-brain radiotherapy

Source: https://onco.cc/trials/jrosg-99-1/  
OnCo record `jrosg-99-1` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Showed that adding whole-brain radiotherapy to focused radiosurgery for a few brain secondaries does not extend life, though it does halve the chance of new ones appearing.

## Summary

Whole-brain radiotherapy after stereotactic radiosurgery had been standard on the reasoning that micrometastases invisible on scans would otherwise grow. JROSG 99-1 randomised 132 patients with one to four brain metastases, each under 3 cm, at 11 Japanese hospitals between October 1999 and December 2003 to whole-brain radiotherapy with radiosurgery (65) or radiosurgery alone (67).

Median survival was 7.5 months with the combination against 8.0 months with radiosurgery alone, and one-year survival 38.5 against 28.4 percent (p=0.42): no survival difference. Twelve-month brain recurrence was 46.8 percent with whole-brain radiotherapy against 76.4 percent without, so salvage treatment was needed far more often when whole-brain radiotherapy was omitted.

The trial, with the later Alliance N0574 trial that measured cognition directly, moved practice to radiosurgery alone with close MRI surveillance for patients with a limited number of brain metastases, accepting more salvage in exchange for better cognitive function. For lung cancer specifically, the further change is that several targeted drugs, osimertinib, lorlatinib, alectinib and selpercatinib among them, control brain disease by themselves, so radiotherapy is increasingly deferred. QUARTZ separately showed that whole-brain radiotherapy adds nothing to steroids and supportive care in patients with non-small-cell lung cancer unsuitable for surgery or radiosurgery.

## Fields

- Kind: Trial
- Status: mixed
- Last checked: 2026-09-25
- Also known as: JROSG 99-1; Aoyama trial
- Phase: 3
- Setting: One to four brain metastases, each under 3 cm: stereotactic radiosurgery with up-front whole-brain radiotherapy versus stereotactic radiosurgery alone, with overall survival as the primary endpoint
- Sponsor: Japanese Radiation Oncology Study Group
- Enrolled: 132
- Result: Median survival 7.5 against 8.0 months (p=0.42); twelve-month brain recurrence 46.8 percent with whole-brain radiotherapy against 76.4 percent without.
- Outcomes: Overall survival (median): Whole-brain radiotherapy with radiosurgery 7.5 months vs Radiosurgery alone 8 months; Brain tumour recurrence at 12 months: Whole-brain radiotherapy with radiosurgery 46.8% vs Radiosurgery alone 76.4%
- Replication: Alliance N0574 reproduced the absence of a survival difference and showed worse cognitive decline with whole-brain radiotherapy; QUARTZ showed no benefit from whole-brain radiotherapy at all in unfit patients with non-small-cell lung cancer.

## Sources

- JROSG 99-1 (JAMA 2006): https://doi.org/10.1001/jama.295.21.2483
- UMIN C000000412: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000000496

## Connected records

- cancers: [Brain metastases (secondary brain tumours)](https://onco.cc/cancers/secondary-brain-tumours/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- technologies: [Palliative radiotherapy](https://onco.cc/technologies/palliative-radiotherapy/), [Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS)](https://onco.cc/technologies/radiosurgery-srs/)
- terms: [Brain metastases (intracranial disease)](https://onco.cc/terms/brain-metastases/), [Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain](https://onco.cc/terms/lung-palliation-breathlessness-effusion-obstruction/), [Palliative](https://onco.cc/terms/palliative-treatment/)
- trials: [QUARTZ](https://onco.cc/trials/quartz/)

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