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

Kann, Benjamin H.; Park, Henry S.; Johnson, Skyler B.; Chiang, Veronica; Yu, James B.

doi:10.6004/jnccn.2017.7003

Cited by 60 publications

(40 citation statements)

References 28 publications

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“…As evidence supporting the use of SRS for managing brain metastases grows, we would expect SRS rates to rise . While SRS was less frequently used in regional centres, patients living in regional areas were as likely to receive SRS as patients living in metropolitan areas.…”

mentioning

confidence: 99%

Stereotactic radiosurgery for managing brain metastases in Victoria, 2012–2017

Ong

Kang

Ratnayake

et al. 2020

Medical Journal of Australia

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he conventional treatment for brain metastases is whole brain radiotherapy (WBRT). 1 But there has been a gradual move to managing limited brain metastases with stereotactic radiosurgery (SRS), 2 and delaying or avoiding WBRT because of its effects on cognition and quality of life. Data on contemporary SRS practice for managing brain metastases in Australia are, however, very limited. 3 We performed a population-based linkage study, analysing data from the Victorian Cancer Registry and the Victorian Radiotherapy Minimum Data Set (VRMDS). We included all patients with solid tumours (ICD-10 codes C00-C80), but excluding primary central nervous systems malignancies (ICD-10 codes C69-72), who received brain radiotherapy in Victoria between 1

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mentioning

confidence: 99%

Stereotactic radiosurgery for managing brain metastases in Victoria, 2012–2017

Ong

Kang

Ratnayake

et al. 2020

Medical Journal of Australia

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“…Kann et al . identified several progressively widening sociodemographic disparities in the adoption of SRS in the United States. While the reasons for these disparities are not well quantified, the lack of availability of specialized treatment machines and human skills and resources are a reasonable hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…With ring-based machines, that is not a concern and it is practical to envision that SRS delivery with head flexion could be delivered in an efficient and safe manner with limited staffing and resources. Kann et al 27 identified several progressively widening sociodemographic disparities in the adoption of SRS in the United States. While the reasons for these disparities are not well quantified, the lack of availability of specialized treatment machines and human skills and resources are a reasonable hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Lateral head flexion as a noncoplanar solution for ring gantry stereotactic radiosurgery

et al. 2019

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Purpose Ring gantry radiotherapy devices are often limited to deliver beams in the axial plane, severely limiting beam entrance angles and rendering noncoplanar beam delivery impossible. However, a ring gantry geometry greatly simplifies delivery machines and increases the efficiency of treatment with the potential to decrease the overall costs of radiotherapy. This study explores the use of lateral head flexion in order to increase beam entrance angles and extend the available solid angle space for a ring gantry stereotactic radiosurgery (SRS) application. Materials and methods A 1.5 T magnetic resonance imaging scanner was used to scan seven healthy volunteers at three different head positions: a neutral position, a left lateral flexion position and a right lateral flexion position. The lateral flexion scans were co‐registered to the neutral head position scan using rigid registration and extracting the rotational transformation. The head pitch, roll, and yaw were computed for each registration to evaluate the natural range of motion for all volunteers. A ring gantry plan geometry was used to generate two sets of single fraction SRS plans (21 Gy): one coplanar set for head neutral scans, and a three‐arc plan set using the head neutral and lateral head flexion scans. The conformity index (CI), intermediate dose fall‐off (R50), low dose spillage (R10), and gradient measure (GM) were used to evaluate both sets of plans. The treatment plans were generated for a ring‐gantry linear accelerator (linac) (Varian Halcyon 2.0) as well as radiosurgery linac (Varian Edge) for comparison. Results The average pitch, yaw, and roll for the lateral head flexion scans were 4.1° ± 4.7°, 16.9° ± 3.7°, and 2.5° ± 4.9° for the right flexion and 4.9° ± 4.3°, 14.0° ± 3.7° and 2.8° ± 5.4° for left flexion. When comparing the head flexion technique with a fully coplanar geometry, the ring gantry plans showed an average improvement in CI of 7.3% (1.46 ± 0.25 vs 1.36 ± 0.28), a decrease of 13% in R50 (5.46 ± 1.14 vs 4.78 ± 1.12), a decrease of 32% in R10 (85.7 ± 20.3 vs 58.2 ± 15.1), and a decrease of 7.8% in GM (0.53 ± 0.05 vs 0.49 ± 0.04). The Edge plans showed an average improvement in CI of 3.0% (1.49 ± 0.26 vs 1.45 ± 0.25), a decrease of 6.8% in R50 (5.19 ± 1.03 vs 4.82 ± 0.83), a decrease of 29% in R10 (84.1 ± 16.3 vs 59.9 ± 12.5), and a decrease of 5.0% in GM (0.50 ± 0.04 vs 0.47 ± 0.03). Conclusion Lateral head flexion was shown to increase beam entrance angles considerably improving plan conformity and normal tissue sparing in this pilot study of seven sets of plans. Rigid registrations demonstrated each lateral flexion to be analogous to a 15° couch kick. The head flexion technique outlined here was shown to be a feasible solution for SRS treatments being delivered on ring gantry devices.

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“…[21][22][23][24] However, although the NCDB captures approximately 70% of newly diagnosed cancer cases, to our knowledge melanoma is the least well-captured cancer type: it is estimated that only approximately one-half of all cases are represented by this database. Many studies have used the NCDB due to its robust reporting of information regarding individual cases, including treatment follow-up, quality-of-care metrics, and greater number of cases captured compared with alternative databases.…”

Section: Limitationsmentioning

confidence: 99%

“…Many studies have used the NCDB due to its robust reporting of information regarding individual cases, including treatment follow-up, quality-of-care metrics, and greater number of cases captured compared with alternative databases. [21][22][23][24] However, although the NCDB captures approximately 70% of newly diagnosed cancer cases, to our knowledge melanoma is the least well-captured cancer type: it is estimated that only approximately one-half of all cases are represented by this database. 25 This is most likely attributed to the fact that early-stage melanoma is more likely to be diagnosed outside of the hospital setting and subsequently missed by the NCDB; however, patients with an initial melanoma diagnosis in the community later may be treated in the hospital setting and therefore be captured.…”

Section: Limitationsmentioning

confidence: 99%

Quantitative associations between health insurance and stage of melanoma at diagnosis among nonelderly adults in the United States

Abudu

Cook

Gershenwald

et al. 2019

Cancer

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Background Health insurance plays a critical role in the accessibility to and quality of health care for patients with melanoma in the United States. Current knowledge regarding the association between insurance status and stage of melanoma is limited because few studies to date have simultaneously controlled for factors known to influence the risk of diagnosis of late‐stage melanoma. The current study was conducted to examine the association between health insurance status and stage of melanoma at the time of diagnosis in nonelderly adults, accounting for known risk factors for late‐stage diagnosis. Methods In this cross‐sectional study, the authors analyzed the National Cancer Data Base for cases of invasive melanoma diagnosed between 2004 and 2015 among individuals aged 26 to 64 years. Using the American Joint Committee on Cancer melanoma staging system, early‐stage melanoma was defined as stage I or stage II whereas late‐stage melanoma was defined as stage III or stage IV. Late‐stage diagnosis was the primary outcome compared across 4 insurance types (private, Medicaid, none, and unknown). Adjusted covariates were age, sex, race/ethnicity, educational level, income, year of diagnosis, number of comorbidities, and facility location. Logistic regression was used for univariable and multivariable analyses. Results Among 177,247 cases, individuals with Medicaid or no health insurance were found to have 3.12 (95% CI, 2.97‐3.28) and 2.21 (95% CI, 2.10‐2.33) times greater odds, respectively, of being diagnosed with late‐stage melanoma compared with individuals with private insurance after adjusting for risk factors in late‐stage diagnosis. Conclusions Future investigation into insurance disparities in the diagnosis of late‐stage melanoma may help to prioritize melanoma screening in populations with nonprivate insurance.

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

Cited by 60 publications

References 28 publications

Stereotactic radiosurgery for managing brain metastases in Victoria, 2012–2017

Stereotactic radiosurgery for managing brain metastases in Victoria, 2012–2017

Lateral head flexion as a noncoplanar solution for ring gantry stereotactic radiosurgery

Quantitative associations between health insurance and stage of melanoma at diagnosis among nonelderly adults in the United States

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