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Stereotactic radiosurgery practice patterns for brain metastases in the United States: a national survey

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Background

Stereotactic radiosurgery (SRS) has emerged as an important modality for the treatment of intracranial metastases. There are currently few established guidelines delineating indications for SRS use and fewer still regarding plan evaluation in the treatment of multiple brain metastases.

Methods

An 18 question electronic survey was distributed to radiation oncologists at National Cancer Institute (NCI) designated cancer centers in the USA (60). Centers without radiation oncologists were excluded. Physicians who indicated that they do not prescribe SRS were excluded from the remaining survey questions. Sign test and Chi-square test were used to determine if responses differed significantly from random distribution.

Results

One hundred sixteen of the 697 radiation oncologists surveyed completed the questionnaire, representing 51 institutions. Sixty-two percent reported treating patients with brain metastases using SRS. Radiation oncologists prescribing SRS most commonly treat CNS (66.2%) and lung (49.3%) malignancies. SRS was used more frequently for < 10 brain metastases (73.7%; p < 0.0001) and whole brain radiation therapy (WBRT) for > 10 brain metastases (82.5%; p < 0.0001). The maximum number of lesions physicians were willing to treat with SRS without WBRT was 1–4 (40.4%) and 5–10 (42.4%) (p < 0.0001 compared to 11–15, 16–20 and no limit). The most important criteria for choosing SRS or WBRT were number of lesions (p < 0.0001) and performance status (p = 0.016). The most common margin for SRS was 0 mm (49.1%; p = 0.0021). The most common dose constraints other than critical structure was conformity index (84.2%) and brain V12 (61.4%). The LINAC was the most common treatment modality (54.4%) and mono-isocenter technique for multiple brain metastases was commonly used (43.9%; p = 0.23). Most departments do not have a policy for brain metastases treatment (64.9%; p = 0.024).

Conclusions

This is one of the first national surveys assessing the use of SRS for brain metastases in clinical practice. These data highlight some clinical considerations for physicians treating brain metastases with SRS.

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Authors and Affiliations

  1. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Erik Scott Blomain, Deepak Bhamidipati, Jenny Guo & Ingrid Kalchman

  2. Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA, 19107, USA

    Hyun Kim, Shivank Garg & Wenyin Shi

  3. Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    John McAna

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  1. Erik Scott Blomain
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Correspondence to Wenyin Shi.

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Funding

E.S.B. received an F30 Ruth Kirschstein MD-PhD Fellowship Award (CA180500).

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required. This is approved by our institutional IRB.

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Blomain, E.S., Kim, H., Garg, S. et al. Stereotactic radiosurgery practice patterns for brain metastases in the United States: a national survey. J Radiat Oncol 7, 241–246 (2018). https://doi.org/10.1007/s13566-018-0353-8

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  • DOI: https://doi.org/10.1007/s13566-018-0353-8

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