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. 2024;9(2):101-111.

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

Benjamin J Rich  1 , Timoteo Almeida  1 , Jared A Maas  2 , Shahil Mehta  3 , Raj Singh  4 , Haley K Perlow  5 , Benjamin Silver  6 , Eric J Lehrer  7 , Yash Soni  1 , William H Jin  1 , Crystal S Seldon  1 , Gregory Azzam  1 , Raphael Yechieli  1 , Gregory Kubicek  1 , Ricardo J Komotar  8 , Carolina G Benjamin  8 , Tejan Diwanji  9 , Eric A Mellon  1
Affiliations

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

Benjamin J Rich et al. J Radiosurg SBRT. 2024.

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.

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Conflict of interest statement

This research was supported through funds provided by the University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center Department of Radiation Oncology. No external funding or grants were used for this work. Authors’ disclosure of potential conflicts of interest The authors have nothing to disclose.

Figures

Figure 1
Figure 1
Patient satisfaction and experience survey response for initial stereotactic radiosurgery or fractionated stereotactic radiotherapy for brain metastases. Select question results shown pertaining to (A) patient satisfaction as well as experience (B) during, (C) 1-5 days after and (D) months to years after stereotactic radiosurgery or fractionated stereotactic radiotherapy. N=30
Figure 2
Figure 2
Patient experience with consent process and decision making for the initial stereotactic radiosurgery or radiotherapy for brain metastases. Depicted are the patients’ reported feelings about their initial stereotactic radiosurgery or radiotherapy risks and benefit discussion with their (A) doctors, (B) radiation oncologist, (C) neurosurgeon, and (D) neuro-oncologist. Patients reported (E) who helped the most with their treatment decision and (F) whether the option of whole brain radiation therapy (WBRT) was discussed. N=30
Supplementary Figure 1.
Supplementary Figure 1.
Patient reported long-term symptoms following upfront SRS for brain metastases as reported by sex. There were significant differences by the Fisher’s Exact Test (2- sided) with P=.017. N=30.
Supplementary Figure 2.
Supplementary Figure 2.
Patients reported who was the most important person in making their treatment decision for upfront stereotactic radiosurgery (SRS). This was broken down by if the patient had received a craniotomy prior to SRS (definitive versus post-operative SRS). There were significant differences by the Pearson Chi-Square with P=.042. N=30.
Supplementary Figure 3.
Supplementary Figure 3.
Impact of the coronavirus 2019 (COVID-19) pandemic on delays in brain metastases (A) diagnosis or (B) treatment as well as difficulty with (C) the consent process or (D) follow-up. N=30.
Supplementary Figure 4.
Supplementary Figure 4.
Patient preferences for first intracranial salvage therapy for a hypothetical intracranial failure after initial stereotactic radiosurgery or fractionated stereotactic radiotherapy for brain metastases. Patients reported if they would consider radiosurgery again (A) in general, (B) if a single tumor developed, (C) if multiple tumors developed, (D) if general anesthesia was used, or (E) if a frameless mask was used. Patient preference for salvage whole brain radiation therapy (WBRT) or radiosurgery if a new tumor developed in (F) one month or (G) one year. N=30.
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