Stereotactic radiosurgery practice patterns for brain metastases in the United States: a national survey

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.

Clinical dose profile of Gamma Knife stereotactic radiosurgery for extensive brain metastases

“…Based on a recent survey, the majority of American radiation oncologists are preferentially treating up to 10 brain metastases with SRS, if not more. 20 Before the widespread use of SRS, many centers typically used WBRT at a standard dose of 30 Gy in 10 fractions for patients with metastatic cancer regardless of the number of metastases. The impetus for a substantially lower brain dose is reflected in the well-known significant neurocognitive effects of WBRT and an increased risk of leukoencephalopathy.…”

Simultaneous radiosurgery for multiple brain metastases: technical overview of the UCLA experience

“…Radiation therapy treatments for multiple brain metastases patients include whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) or hypofractionated radiotherapy for larger targets [ 1 , 2 ]. Stereotactic radiosurgery for multiple brain metastases has historically been treated with multiple isocenters, typically one isocenter per lesion for linac-based deliveries.…”

Mean Brain Dose Remains Uninfluenced by the Lesion Number for Gamma Knife Stereotactic Radiosurgery for 10+ Metastases

“…In an effort to avoid known neurocognitive side effects of WBRT, radiation oncologists are increasingly choosing SRS over WBRT for treatment of high-burden intracranial disease. In a recent survey of American radiation oncologists, 42.4% of physicians stated their willingness to treat up to ten intracranial lesions without WBRT, while 17.2% were willing to treat more [9]. As studies of patients treated with SRS for extensive BM continue to demonstrate the safety and e cacy of such an approach, these percentages will likely rise [10][11][12][13][14].…”