Changing practice patterns of Gamma Knife versus linear accelerator-based stereotactic radiosurgery for brain metastases in the US

Park, Henry S.; Wang, Elyn H.; Rutter, C.E.; Corso, Christopher D.; Chiang, Veronica; Yu, James B.

doi:10.3171/2015.4.jns1573

Cited by 55 publications

(43 citation statements)

References 14 publications

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“…We also identified socioeconomic factors associated with preferential use of SRS: residence in higher-educated regions, household income, and the type of medical insurance. Similar factors have also been to predict for the use of SRS for brain metastasis from other histologies [17,18].…”

Section: Discussionmentioning

confidence: 91%

Stereotactic radiosurgery for brain metastases from newly diagnosed small cell lung cancer: practice patterns and outcomes

et al. 2019

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Background: Up-front stereotactic radiosurgery (SRS) has been historically thought of as inadequate for brain metastases (BM) from newly diagnosed small cell lung cancer (SCLC). This study evaluates national practice patterns and clinical outcomes for BM from SCLC. Material and methods: The National Cancer Database was queried (2004-2013) for patients with newly diagnosed metastatic SCLC receiving intracranial radiotherapy. Patients were grouped into three categories: upfront SRS, whole-brain radiotherapy (WBRT) alone, or WBRT with boost (SRS or fractionated radiotherapy). Statistics included temporal trend assessment by annual percent change (APC), logistic regression, exploratory Kaplan-Meier overall survival (OS) analysis without and with propensity matching, and Cox proportional hazards modeling. Results: A total of 14,722 patients met selection criteria, of whom 487 (3.3%), 13,657 (92.8%), and 578 (3.9%) received upfront SRS, WBRT and WBRT with boost, respectively. Utilization of SRS showed a slight increasing trend from 2004 to 2013 (2.7-4.3%). In addition to socioeconomic factors, other variables associated with SRS use included diagnosis after 2010, treatment at academic centers, and residing in higher-educated regions. SRS was less often delivered to patients with node-positive disease (p < .05). On exploratory analysis, SRS cohort was observed to have a higher overall survival (OS) than WBRT-based groups (p < .001), namely in patients without extracranial metastases. Conclusions: Utilization of up-front SRS for SCLC BM has been increasing over time but is driven by socioeconomic disparities. Although there are likely numerous biases associated with the OS findings herein, further research is needed to validate this finding as well as the role of SRS on patients with brain metastases due to SCLC.

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Section: Discussionmentioning

confidence: 91%

Stereotactic radiosurgery for brain metastases from newly diagnosed small cell lung cancer: practice patterns and outcomes

et al. 2019

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“…When we repeated analysis of our data after imposing the criteria of the Yamamoto study, the median overall survivals obtained were comparable (Table 3). The apparent difference in the survival intervals between these two studies highlights the challenges in generalizing data from trials involving selected cohorts to the general patient population that clinicians treat on a daily basis 22,23 .…”

Section: Discussionmentioning

confidence: 99%

Survival Patterns of 5750 Stereotactic Radiosurgery–Treated Patients with Brain Metastasis as a Function of the Number of Lesions

et al. 2017

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Background The number of brain metastases (BM) plays an important role in the decision between stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT). Methods We analyzed the survival of 5750 SRS-treated BM patients as a function of BM number. Survival analyses were performed using Kaplan-Meier analysis as well as univariate and multivariate Cox proportional hazards models. Results BM patients were first categorized as those with 1, 2–4, and 5–10 BM based on the scheme proposed by Yamamoto et al (Lancet Oncology 2014). Median overall survival for patients with 1 BM was superior to those with 2–4 BMs (7.1 mo v. 6.4 mo, p=0.009), and survival of patients with 2–4 BMs did not differ from those with 5–10 BMs (6.4 mo v. 6.3 mo, p=0.170). The median survival of patients with >10 BMs was lower than those with 2–10 BMs (6.3 mo v. 5.5 mo, p=0.025). In a multivariate model that accounted for age, Karnofsky Performance Score (KPS), systemic disease status, tumor histology, and cumulative intracranial tumor volume (CITV), we observed a ~10% increase in hazard of death when comparing patients with 1 versus 2–10 BM (p<0.001) or 10 versus >10 BM (p<0.001). When BM number was modeled as a continuous variable rather than using the Yamamoto classification, we observed a step-wise 5% increase in the hazard of death for every increment of 5–6 BM (p<0.001). Conclusions The contribution of BM number to overall survival is modest, and should be considered as one of the many variables considered in the decision between SRS and WBRT.

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“…Additionally, further refinement of SRS technology occurred during our study period, including adoption of linear accelerator-based SRS 25 and other frame- less SRS systems, 26 which may have contributed to increased uptake.…”

Section: Discussionmentioning

confidence: 99%

Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States

Kann¹,

Park²,

Johnson³

et al. 2017

J Natl Compr Canc Netw

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Background: Management of brain metastases typically includes radiotherapy (RT) with conventional fractionation and/or stereotactic radiosurgery (SRS). However, optimal indications and practice patterns for SRS remain unclear. We sought to evaluate national practice patterns for patients with metastatic disease receiving brain RT. Methods: We queried the National Cancer Data Base (NCDB) for patients diagnosed with metastatic non-small cell lung cancer, breast cancer, colorectal cancer, or melanoma from 2004 to 2014 who received upfront brain RT. Patients were divided into SRS and non-SRS cohorts. Patient and facility-level SRS predictors were analyzed with chi-square tests and logistic regression, and uptake trends were approximated with linear regression. Survival by diagnosis year was analyzed with the Kaplan-Meier method. Results: Of 75,953 patients, 12,250 (16.1%) received SRS and 63,703 (83.9%) received non-SRS. From 2004 to 2014, the proportion of patients receiving SRS annually increased (from 9.8% to 25.6%; P<.001), and the proportion of facilities using SRS annually increased (from 31.2% to 50.4%; P<.001). On multivariable analysis, nonwhite race, nonprivate insurance, and residence in lowerincome or less-educated regions predicted lower SRS use (P<.05 for each). During the study period, SRS use increased disproportionally among patients with private insurance or who resided in higher-income or higher-educated regions. From 2004 to 2013, 1-year actuarial survival improved from 24.1% to 49.6% for patients selected for SRS and from 21.0% to 26.3% for non-SRS patients (P<.001). Conclusions: This NCDB analysis demonstrates steadily increasing-although modest overall-brain SRS use for patients with metastatic disease in the United States and identifies several progressively widening sociodemographic disparities in the adoption of SRS. Further research is needed to determine the reasons for these worsening disparities and their clinical implications on intracranial control, neurocognitive toxicities, quality of life, and survival for patients with brain metastases.

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Changing practice patterns of Gamma Knife versus linear accelerator-based stereotactic radiosurgery for brain metastases in the US

Cited by 55 publications

References 14 publications

Stereotactic radiosurgery for brain metastases from newly diagnosed small cell lung cancer: practice patterns and outcomes

Stereotactic radiosurgery for brain metastases from newly diagnosed small cell lung cancer: practice patterns and outcomes

Survival Patterns of 5750 Stereotactic Radiosurgery–Treated Patients with Brain Metastasis as a Function of the Number of Lesions

Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States

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