Clinical Scorecard: Trends in Stereotactic Radiosurgery for Brain Metastases: Insights from the National Cancer Database (2004–2020)
At a Glance
Category
Detail
Condition
Brain metastases (BM) in cancer patients
Key Mechanisms
Stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) as radiotherapy modalities for BM
Target Population
Adult patients (≥18 years) with brain metastases from various primary cancers in the United States
Care Setting
Hospital-based oncology care facilities accredited by the American College of Surgeons and American Cancer Society
Key Highlights
SRS offers comparable survival outcomes to WBRT with reduced neurocognitive toxicity, leading to increased preference since 2016.
Disparities in SRS utilization exist related to race, ethnicity, socioeconomic status, insurance coverage, geographic location, and healthcare access.
Medicaid expansion and institutional factors may influence access to SRS, with marginalized populations more likely to receive WBRT and experience treatment delays.
Guideline-Based Recommendations
Diagnosis
Use National Comprehensive Cancer Network guidelines to define SRS and WBRT treatment modalities based on radiotherapy fractionation and technique.
Classify brain metastases using clinical and sociodemographic data including race, ethnicity, income, education, insurance, and comorbidity scores.
Management
Consider SRS for patients with limited brain metastases or select extensive disease cases to reduce neurotoxicity.
WBRT remains a treatment option for extensive brain metastases but is associated with higher neurocognitive risks.
Monitoring & Follow-up
Monitor treatment patterns and access disparities over time using comprehensive databases like the National Cancer Database.
Assess sociodemographic factors and healthcare access to identify and address disparities in treatment utilization.
Risks
WBRT is associated with higher neurocognitive toxicity compared to SRS.
Disparities in access to SRS may lead to delayed treatment and worse outcomes in marginalized populations.
Patient & Prescribing Data
Adult patients with brain metastases from twelve common primary cancers treated with radiotherapy between 2004 and 2020 in the United States.
SRS utilization has increased over time but remains unevenly distributed due to socioeconomic, racial, and geographic disparities; patients from marginalized groups are less likely to receive SRS.
Clinical Best Practices
Utilize SRS preferentially for eligible patients with limited brain metastases to minimize neurocognitive side effects.
Incorporate detailed sociodemographic data including disaggregated racial and ethnic categories to better understand and address treatment disparities.
Leverage healthcare policy changes such as Medicaid expansion to improve access to advanced treatments like SRS.
Ensure treatment decisions consider patient comorbidities, insurance status, and proximity to specialized centers offering SRS.
Continuously monitor national treatment trends and disparities using large oncology databases to inform equitable care delivery.
by Jonathan J. Shih, Bhav Jain, Rohan Patel, Urvish Jain, Miranda Lam, Fumiko Chino, Manali I. Patel, Edward Christopher Dee, Erqi Pollom, Gordon Li, Kekoa Taparra
