More than 20% of patients with cancer will develop brain metastases.1 Primary malignancies most commonly associated with brain metastases are lung, breast, and gastrointestinal cancers and melanoma, constituting up to 80% of brain metastases.1–3 Management of brain metastases often consists of tumor-directed treatment with radiotherapy (RT). Traditionally, RT had been administered with conventionally fractionated whole-brain RT (WBRT), although over the past several decades, stereotactic radiosurgery (SRS), targeted at individual cranial lesions, has become accepted.4–6 Several randomized trials demonstrated equivalent survival with upfront SRS and WBRT for patients with 1 to 3 brain metastases.7,8 In the context of these trials, there was a modest national increase in SRS use observed in Medicare patients with metastatic non–small cell lung cancer (NSCLC) from 2000 to 2005.9 Since then, several randomized trials showed that SRS upfront without WBRT did not compromise survival and was associated with fewer adverse neurocognitive effects.10–12 SRS use may also vary by primary disease site.13,14 Additionally, cost concerns and access to facilities with SRS programs may vary and introduce disparities for certain patient groups.
Utilization of SRS may vary widely on a national scale.15,16 Therefore, we sought to evaluate recent national SRS treatment patterns, institutional adoption, and disparities across 4 of the malignancies most associated with brain metastases in the United States.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
See JNCCN.org for supplemental online content.
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