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1394 www.thelancet.com Vol 389 April 8, 2017 brain radiotherapy (WBRT) versus optimal supportive care in patients with non-small cell lung cancer (NSCLC) and brain metastases. We commend the authors on undertaking this important study. This study validates the practice pattern of withholding WBRT in patients that will not live long enough to derive benefit from intracranial control. However, we caution against overgeneralisation of the results to all patients. This multicentre study randomised 538 patients between March, 2007, and August, 2014, from 72 centres in the UK and Australia. These numbers suggest that, on average, only one patient per centre was enrolled annually, and might reflect selection bias in which only patients with the poorest of expected outcomes were enrolled. This hypothesis is consistent with a median survival among the entire cohort of 2 months and that approximately 10% of patients assigned to WBRT either died before receiving WBRT or declined to the point that WBRT could no longer be given. Patients were enrolled on this trial if they were “unsuitable for surgical resection or stereotactic radiotherapy”, yet approximately two-thirds of patients had four lesions or fewer; recently published randomised trials indicate that few situations exist in which patients with four brain metastases or fewer should be treated with WBRT as opposed to stereotactic radiation. Had this study started enrolment in 2016, it is plausible that few patients would have met eligibility criteria. Despite the patient selection issues noted above, some groups of patients appeared to show potential survival benefit with WBRT, including patients younger than 70 years of age, those with a Karnofsky Performance Status of at least 70, and those with controlled systemic disease. Given that only 10–25% of patients with brain metastases die of neurological disease, an improvement in overall DFCI counts among its core values the pursuit of integrity “in all that we do, adhering always to the highest standards of conduct”. In holding its fundraiser at Mar-a-Lago, DFCI acted both cowardly and myopically without apparent consideration of the long-term implications of what will be interpreted by many as a symbolic endorsement of Trump. In doing so, DFCI lost a rare opportunity to lead and the respect of many of its advocates.