Keywords:
CNS, Gamma knife, Stereotactic radiotherapy, Metastases, Patterns of Care
Authors:
K. Tran1, C. Phillips1, M. Pinkham2, M. Izard3, A. Moore4, J. Lehmann5, J. Shakeshaft2, B. Chua6, V. Estall7, J. Ruben8; 1Parkville, VIC/AU, 2Woolloongabba, QLD/AU, 3North Sydney, NSW/AU, 4Waratah, NSW/AU, 5Newcastle, NSW/AU, 6Brisbane, QLD/AU, 7Geelong, VIC/AU, 8Melbourne, VIC/AU
DOI:
10.26044/ranzcr2021/R-0160
Purpose
The TROG Cancer Research Stereotactic Radiosurgery Subcommittee surveyed current patterns of practice in radiation therapy of brain metastases (BM) to better understand current standards and inform future clinical trial designs.
Brain metastases (BM) are present in 10-30% of cancer patients.1 The incidence of brain metastases is increasing, likely a result of both improvements in detection of small metastases by magnetic resonance imaging (MRI) and better control of extracranial disease resulting from improved systemic therapy.
The primary approaches to the treatment of BM include surgery, stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT).
Management of BM needs to be tailored to individual patients based on patient factors such as, age, performance status and medical comorbidities, presence of symptoms; tumour factors such as, solid tumour type, volume (and number) of metastases, location of BM, control of extracranial disease burden and presence of targetable mutations and finally treatment factors, surgical expertise and SRS capacity of radiation oncology centres.
Traditionally WBRT was considered a primary treatment modality for many patients with a high intracranial tumour burden, the routine role of WBRT as adjunctive therapy in patients who are candidates for SRS or surgical resection has evolved as randomized trials have shown that despite improved rates of intracranial disease control, adjunctive WBRT does not improve overall survival and decreases quality of life due to side effects and neurocognitive decline.
The Trans Tasman Radiation Oncology Group (TROG) Cancer Research SRS subcommittee is a special interest group looking to create consensus guidelines in the management of BM. They invited Rdiation oncologists in Australia, New Zealand and Singapore to complete a patterns of practice survey. The aim of this survey was to explore current practice in the management of BM.