{"entity":{"id":"paper-alliance-n0574-brown-jama-2016","kind":"paper","name":"Alliance N0574: radiosurgery alone versus radiosurgery plus whole-brain radiotherapy for one to three brain metastases","aka":[],"tldr":"Adding whole-brain radiotherapy to focused radiosurgery for a few brain metastases caused more memory and thinking problems without lengthening life, so radiosurgery alone became standard for limited brain metastases.","summary":"Phase 3 trial of 213 patients with one to three brain metastases randomised to stereotactic radiosurgery alone or radiosurgery plus whole-brain radiotherapy, with cognitive decline at three months as the primary endpoint.\n\nCognitive deterioration was more frequent with whole-brain radiotherapy (91.7 versus 63.5 percent) despite better intracranial control, and median overall survival did not differ (10.4 versus 7.4 months, not significant).","asOf":"2026-09-17","links":[{"label":"JAMA 2016","url":"https://doi.org/10.1001/jama.2016.9839"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/27458945/"}],"tags":[],"related":[],"cancers":["secondary-brain-tumours"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["alliance-n0574"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jama"],"dependsOn":[],"notes":[],"journal":"JAMA","year":2016,"doi":"10.1001/jama.2016.9839","pmid":"27458945","authors":"Brown PD, Jaeckle K, Ballman KV, et al.","paperType":"rct","findings":["Cognitive deterioration at three months 91.7 percent vs 63.5 percent.","Intracranial control at one year better with whole-brain radiotherapy (85 vs 51 percent) without a survival difference."],"whatItMeans":"Patients with a limited number of brain metastases are treated with radiosurgery alone and surveillance, accepting more new brain lesions in return for preserved cognition.","caveats":["Cognitive testing only assessed to three months in the primary endpoint.","Modern hippocampal-avoidance whole-brain radiotherapy was not used."],"changedPractice":true,"participants":213},"route":"/key-papers/paper-alliance-n0574-brown-jama-2016/","neighbours":{"cancer":[{"id":"secondary-brain-tumours","kind":"cancer","name":"Brain metastases (secondary brain tumours)","route":"/cancers/secondary-brain-tumours/"}],"trial":[{"id":"alliance-n0574","kind":"trial","name":"Alliance N0574 (NCCTG N0574)","route":"/trials/alliance-n0574/"}],"journal":[{"id":"jama","kind":"journal","name":"JAMA","route":"/journals/jama/"}]}}