Patient and physician attitudes towards salvage stereotactic radiosurgery or radiotherapy for brain metastases

Benjamin J Rich; Timoteo Almeida; Jared A Maas; Shahil Mehta; Raj Singh; Haley K Perlow; Benjamin Silver; Eric J Lehrer; Yash Soni; William H Jin; Crystal S Seldon; Gregory Azzam; Raphael Yechieli; Gregory Kubicek; Ricardo J Komotar; Carolina G Benjamin; Tejan Diwanji; Eric A Mellon

Patient and physician attitudes towards salvage stereotactic radiosurgery or radiotherapy for brain metastases

J Radiosurg SBRT. 2024;9(2):101-111.

Authors

Benjamin J Rich¹, Timoteo Almeida¹, Jared A Maas², Shahil Mehta³, Raj Singh⁴, Haley K Perlow⁵, Benjamin Silver⁶, Eric J Lehrer⁷, Yash Soni¹, William H Jin¹, Crystal S Seldon¹, Gregory Azzam¹, Raphael Yechieli¹, Gregory Kubicek¹, Ricardo J Komotar⁸, Carolina G Benjamin⁸, Tejan Diwanji⁹, Eric A Mellon¹

Affiliations

¹ Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
² Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
⁴ Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA, USA.
⁵ Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁶ Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
⁷ Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY USA.
⁸ Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA.
⁹ Department of Radiation Oncology, South Baltimore County Medical Center, Halethorpe, MD, USA.

PMID: 39087061
PMCID: PMC11288657 (available on 2025-01-01)

Abstract

Background: The experience of patients with brain metastases treated with stereotactic radiosurgery (SRS) may shape attitudes towards salvage therapy. Furthermore, physician attitudes towards salvage therapy may differ based on specialty and experience. Our objective is to compare physician attitudes and patient experiences with SRS.

Methods: Eligible patients with brain metastases treated with one course of SRS or fractionated stereotactic radiotherapy (FSRT) without whole brain radiotherapy (WBRT) in the definitive or postoperative setting at a single institution were surveyed from 11/2021 to 11/2022 regarding their perspectives on salvage therapy. A separate 11-question multi-disciplinary physician survey was distributed to residents, fellows and attendings at seven additional academic institutions in the US. Chi-square test and Mann-Whitney U test were used to assess differences.

Results: A total of 30 patients and 88 physicians were surveyed. Most patients reported being satisfied or very satisfied with initial SRS/FSRT (90%). When given an option between WBRT or SRS for salvage treatment, all patients favored SRS. The physicians consisted of radiation oncologists (69.3%), neurosurgeons (19.3%), medical oncologists (8.0%), and neuro-oncologists (3.4%). Most physicians were confident or very confident in their ability to discuss the risks and benefits of SRS for brain metastases (78.9%), but this was significantly lower if the patient had received prior SRS (56.6%, P<.001). In these cases, there were significant differences in response by medical specialty and confidence level (P<0.05).

Conclusions: Patients and physicians view tumor control followed by long-term toxicity as the most important factors for salvage therapy after initial SRS for brain metastases.

Keywords: brain metastasis; quality of life; radiosurgery; radiotherapy; survey.