Shearwood McClelland Iii1, Catherine Degnin2, Yiyi Chen2, Gordon A Watson1, Jerry J Jaboin3. 1. Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA. 2. Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR, USA. 3. Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA.
Abstract
INTRODUCTION: Stereotactic radiosurgery (SRS) for brain metastases is predominantly delivered via single-fraction Gamma Knife SRS (GKRS) or linear accelerator (LINAC) in up to five fractions. Predictors of SRS modality have been sparsely examined on a nationwide level. METHODS: An observational cohort study was performed on patients receiving SRS for brain metastases from non-small cell lung cancer from 2010 to 2016 at Commission on Cancer-accredited hospitals throughout the United States (US). A multivariable logistic regression model characterized SRS receipt, adjusting for patient age, dose, geographic location of treatment, facility type, and distance from treatment facility. RESULTS: A total of 2,684 patients received GKRS, while 1,643 patients received LINAC SRS. After adjusting for significant covariates, treatment at non-academic facilities was associated with increased LINAC SRS receipt, most prominently in the Midwestern (OR=6.23;p<0.001), Northeastern (OR=4.42;p<0.001), and Southern US (OR=1.96;p<0.001). Compared to patients receiving 12-17 Gy, patients receiving doses of 18-19 Gy (OR=1.42;p=0.025), 20-21 Gy (OR=1.82;p<0.001), and 22-24 Gy (OR=3.11;p<0.001) were more likely to receive LINAC SRS; similarly, patients located within 20 miles of a radiation treatment facility were more likely to receive LINAC SRS (OR=1.27;p=0.007). CONCLUSIONS: Despite Gamma Knife being more prominently used over LINAC for SRS, patients treated at a non-academic facility outside of the Western US or requiring increased radiation dose were substantially more likely to receive LINAC over Gamma Knife. Additionally, patients residing in close proximity to a treatment center were 27% more likely to receive LINAC, likely indicative of the increased geographic accessibility of LINAC compared with GKRS.
INTRODUCTION: Stereotactic radiosurgery (SRS) for brain metastases is predominantly delivered via single-fraction Gamma Knife SRS (GKRS) or linear accelerator (LINAC) in up to five fractions. Predictors of SRS modality have been sparsely examined on a nationwide level. METHODS: An observational cohort study was performed on patients receiving SRS for brain metastases from non-small cell lung cancer from 2010 to 2016 at Commission on Cancer-accredited hospitals throughout the United States (US). A multivariable logistic regression model characterized SRS receipt, adjusting for patient age, dose, geographic location of treatment, facility type, and distance from treatment facility. RESULTS: A total of 2,684 patients received GKRS, while 1,643 patients received LINAC SRS. After adjusting for significant covariates, treatment at non-academic facilities was associated with increased LINAC SRS receipt, most prominently in the Midwestern (OR=6.23;p<0.001), Northeastern (OR=4.42;p<0.001), and Southern US (OR=1.96;p<0.001). Compared to patients receiving 12-17 Gy, patients receiving doses of 18-19 Gy (OR=1.42;p=0.025), 20-21 Gy (OR=1.82;p<0.001), and 22-24 Gy (OR=3.11;p<0.001) were more likely to receive LINAC SRS; similarly, patients located within 20 miles of a radiation treatment facility were more likely to receive LINAC SRS (OR=1.27;p=0.007). CONCLUSIONS: Despite Gamma Knife being more prominently used over LINAC for SRS, patients treated at a non-academic facility outside of the Western US or requiring increased radiation dose were substantially more likely to receive LINAC over Gamma Knife. Additionally, patients residing in close proximity to a treatment center were 27% more likely to receive LINAC, likely indicative of the increased geographic accessibility of LINAC compared with GKRS.
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