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01-09-2018 | Original Research

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

Authors: Erik Scott Blomain, Hyun Kim, Shivank Garg, Deepak Bhamidipati, Jenny Guo, Ingrid Kalchman, John McAna, Wenyin Shi

Published in: Journal of Radiation Oncology | Issue 3/2018

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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Title: Stereotactic radiosurgery practice patterns for brain metastases in the United States: a national survey
Authors: Erik Scott Blomain
Hyun Kim
Shivank Garg
Deepak Bhamidipati
Jenny Guo
Ingrid Kalchman
John McAna
Wenyin Shi
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Radiation Oncology / Issue 3/2018
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-018-0353-8

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