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Treatment trends for patients with brain metastases: Does practice reflect the data?
Author(s) -
Sandler Kiri A.,
Shaverdian Narek,
Cook Ryan R.,
Kishan Amar U.,
King Christopher R.,
Yang Isaac,
Steinberg Michael L.,
Lee Percy
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30607
Subject(s) - medicine , radiosurgery , radiation therapy , brain metastasis , central nervous system , radiation oncology , oncology , cancer , metastasis
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 .