Management of brain metastases typically includes radiotherapy (RT) with conventional fractionation and/or stereotactic radiosurgery (SRS). For the 20% of cancer patients who will develop brain metastases, optimal practice patterns for SRS remain unclear.

To assess optimal treatment of this patient population, Benjamin Kann, MD, and colleagues conducted a study–published in the Journal of the National Comprehensive Cancer Network–that examined patients who were diagnosed with metastatic non–small cell lung cancer, breast cancer, colorectal cancer, or melanoma from 2004 to 2014 who received upfront brain RT.

Nearly 76,000 patients were examined, among whom 16.1% received SRS. The proportion of patients who received SRS annually increased from 9.8% to 25.6%, and the proportion of facilities using SRS annually increased from 31.2% to 50.4%. Upon multivariable analysis, non-Caucasian race, non-private insurance, and residence in lower-income or less-educated regions predicted lower SRS use. During the study period, SRS use increased disproportionally among patients with private insurance and those who resided in higher-income or higher-educated regions. From 2004 to 2013, 1-year actuarial survival improved from 24.1% to 49.6% for patients selected for SRS and from 21.0% to 26.3% for non-SRS patients.

“It’s a combination of factors,” Dr. Kann says of the disparities, “including up-front costs, the infrastructure involved, multidisciplinary expertise with radiation oncologists and neurosurgeons, and training required. The study highlights the need to improve access to some of these lower-income and under-privileged populations. There’s a clear correlation between level of insurance and use of this modality.”

Dr. Kann says that further research is needed to determine the reasons for these worsening disparities and their clinical implications on quality of life and survival for patients with brain metastases.