Treatment trends for patients with brain metastases: Does practice reflect the data?

Kiri A Sandler; Narek Shaverdian; Ryan R Cook; Amar U Kishan; Christopher R King; Isaac Yang; Michael L Steinberg; Percy Lee

doi:10.1002/cncr.30607

Treatment trends for patients with brain metastases: Does practice reflect the data?

Cancer. 2017 Jun 15;123(12):2274-2282. doi: 10.1002/cncr.30607. Epub 2017 Feb 8.

Authors

Kiri A Sandler¹, Narek Shaverdian¹, Ryan R Cook², Amar U Kishan¹, Christopher R King¹, Isaac Yang^{3

4}, Michael L Steinberg^{1

3}, Percy Lee^{1

3}

Affiliations

¹ Department of Radiation Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
² Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California.
³ Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
⁴ Department of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.

PMID: 28178376
DOI: 10.1002/cncr.30607

Abstract

Background: Published guidelines regarding the optimal treatment strategies for brain metastases focus on patients with ≤3 lesions. As delivery techniques for stereotactic radiosurgery (SRS) improve, radiation oncologists are increasingly using it for patients with >3 metastases. In the current study, the authors sought to characterize practice patterns among practitioners to identify areas of controversy.

Methods: A survey of practicing radiation oncologists was distributed via e-mail. Responses were collected from April 1 to May 5, 2016. Survey data were analyzed.

Results: A total of 711 currently practicing radiation oncologists responded, for a response rate of 12.5%. Specialists in central nervous system tumors (CNS specialists) were more likely to treat higher numbers of patients with brain metastases with SRS. There was a significant difference in the optimal "cutoff number" used when deciding how many lesions to treat with SRS versus whole-brain radiotherapy. Cutoff numbers were significantly higher for high-volume CNS specialists (≥10 patients/month) than for either low-volume CNS specialists (5-9 patients/month) or high-volume, non-CNS specialists (8.1 vs 5.6 and 5.1, respectively; P<.001). A majority of respondents (56%) identified patients with 4 to 6 brain metastases as being the most challenging patients to treat.

Conclusions: To the authors' knowledge, there appears to be no consensus regarding the optimal treatment strategy among patients with >3 brain metastases, and practice patterns are heterogeneous. Radiation oncologists, especially high-volume CNS specialists, are treating significantly more brain metastases with SRS than what currently is recommended by published consensus guidelines. Providers struggle with patients with a moderate intracranial disease burden. Further prospective studies are needed to support these practice patterns and guide decision making. Cancer 2017;123:2274-2282. © 2017 American Cancer Society.

Keywords: brain metastases; patterns of practice; radiation; stereotactic radiosurgery; whole-brain radiotherapy.

MeSH terms

Brain Neoplasms / radiotherapy*
Brain Neoplasms / secondary
Cranial Irradiation / trends*
Female
Humans
Male
Metastasectomy
Practice Guidelines as Topic
Practice Patterns, Physicians' / trends*
Radiation Oncologists
Radiosurgery / trends*
Surveys and Questionnaires