Stereotactic radiosurgery for brain metastases: evolving practice patterns from the national cancer database (2004–2020)

作者：Jonathan J. Shih, Bhav Jain, Rohan Patel, Urvish Jain, Miranda B. Lam, Fumiko Ladd Chino, Manali I. Patel, Edward Christopher Dee, Erqi Liu Pollom, Gordon Li, Kekoa Taparra · 发表于：Journal of Neuro-Oncology · 年份：2025 · DOI：10.1007/s11060-025-05178-8 · 被引用次数：5 · 研究领域：Brain Metastases and Treatment、Lung Cancer Research Studies、Glioma Diagnosis and Treatment

PURPOSE: Stereotactic radiosurgery (SRS) offers less neurotoxicity and comparable survival to whole-brain radiation therapy (WBRT) for brain metastases (BM). Current SRS practice patterns are understudied. We examined national trends in SRS and WBRT utilization. METHODS: We queried the National Cancer Database for patients with BM from twelve cancers (≥ 18 years; diagnosed 2004–2020) treated with radiotherapy. Patients were grouped by first-course radiotherapy modality (SRS:1–5 fractions; WBRT:5–15 fractions). Multivariable logistic regression assessed SRS predictors, adjusting for sociodemographic and clinical variables. A race*diagnosis year interaction evaluated temporal trends. Difference-in-differences analysis assessed Medicaid expansion impact. RESULTS: Of 89,984 patients, 24,174 (27%) received SRS. SRS utilization rose from 8 to 54% between 2004 and 2020 (P < 0.001). SRS was more likely in patients diagnosed in recent years (aOR = 3.85 [95% CI = 3.70–4.01]), who received prior chemotherapy (aOR = 1.17 [1.13–1.21]) or surgery (aOR = 2.25 [2.11–2.40]), and those with colorectal (aOR = 1.93 [1.64–2.26]), lung (aOR = 1.37 [1.24–1.50]), melanoma (aOR = 2.76 [2.46–3.10]), thyroid (aOR = 2.17 [1.36–3.46]), or kidney/bladder cancer (aOR = 2.76 [2.44–3.12]) versus breast cancer. SRS was less likely in patients with lower income (aOR = 0.88 [0.85–0.92]) or educational attainment (aOR = 0.88 [0.85–0.92]), Medicaid/Medicare (aOR = 0.86 [0.83–0.90]), no insurance (aOR = 0.49 [0.44...