Erik Scott Blomain1, Hyun Kim2, Shivank Garg2, Deepak Bhamidipati1, Jenny Guo1, Ingrid Kalchman1, John McAna3, Wenyin Shi2. 1. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA. 2. Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, USA. 3. Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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.
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.
Entities:
Keywords:
Brain metastases; Practice patterns; SRS; Stereotactic radiosurgery
Authors: Minesh P Mehta; May N Tsao; Timothy J Whelan; David E Morris; James A Hayman; John C Flickinger; Michael Mills; C Leland Rogers; Luis Souhami Journal: Int J Radiat Oncol Biol Phys Date: 2005-09-01 Impact factor: 7.038
Authors: Bodo Lippitz; Christer Lindquist; Ian Paddick; David Peterson; Kevin O'Neill; Ronald Beaney Journal: Cancer Treat Rev Date: 2013-06-27 Impact factor: 12.111
Authors: Eric L Chang; Jeffrey S Wefel; Kenneth R Hess; Pamela K Allen; Frederick F Lang; David G Kornguth; Rebecca B Arbuckle; J Michael Swint; Almon S Shiu; Moshe H Maor; Christina A Meyers Journal: Lancet Oncol Date: 2009-10-02 Impact factor: 41.316
Authors: May N Tsao; Dirk Rades; Andrew Wirth; Simon S Lo; Brita L Danielson; Laurie E Gaspar; Paul W Sperduto; Michael A Vogelbaum; Jeffrey D Radawski; Jian Z Wang; Michael T Gillin; Najeeb Mohideen; Carol A Hahn; Eric L Chang Journal: Pract Radiat Oncol Date: 2012-01-30
Authors: Mark E Linskey; David W Andrews; Anthony L Asher; Stuart H Burri; Douglas Kondziolka; Paula D Robinson; Mario Ammirati; Charles S Cobbs; Laurie E Gaspar; Jay S Loeffler; Michael McDermott; Minesh P Mehta; Tom Mikkelsen; Jeffrey J Olson; Nina A Paleologos; Roy A Patchell; Timothy C Ryken; Steven N Kalkanis Journal: J Neurooncol Date: 2009-12-04 Impact factor: 4.130
Authors: Steven N Kalkanis; Douglas Kondziolka; Laurie E Gaspar; Stuart H Burri; Anthony L Asher; Charles S Cobbs; Mario Ammirati; Paula D Robinson; David W Andrews; Jay S Loeffler; Michael McDermott; Minesh P Mehta; Tom Mikkelsen; Jeffrey J Olson; Nina A Paleologos; Roy A Patchell; Timothy C Ryken; Mark E Linskey Journal: J Neurooncol Date: 2009-12-04 Impact factor: 4.130
Authors: Minesh P Mehta; Nina A Paleologos; Tom Mikkelsen; Paula D Robinson; Mario Ammirati; David W Andrews; Anthony L Asher; Stuart H Burri; Charles S Cobbs; Laurie E Gaspar; Douglas Kondziolka; Mark E Linskey; Jay S Loeffler; Michael McDermott; Jeffrey J Olson; Roy A Patchell; Timothy C Ryken; Steven N Kalkanis Journal: J Neurooncol Date: 2009-12-04 Impact factor: 4.130
Authors: Nzhde Agazaryan; Steve Tenn; Chul Lee; Michael Steinberg; John Hegde; Robert Chin; Nader Pouratian; Isaac Yang; Won Kim; Tania Kaprealian Journal: Radiat Oncol Date: 2021-11-17 Impact factor: 3.481