RTHP-10. PREDICTORS OF LINEAR ACCELERATOR VERSUS GAMMA KNIFE STEREOTACTIC RADIOSURGERY USE FOR BRAIN METASTASES IN THE UNITED STATES

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) for brain metastases is predominantly delivered via single-fraction Gamma Knife SRS (GKRS) or linear accelerator (LINAC) in 1–5 fractions. Predictors of SRS modality have been sparsely examined on a nationwide level. METHODS The 2010–2016 National Cancer Database identified brain metastases patients from non-small cell lung cancer throughout the United States (US) having undergone SRS. A multivariable logistic regression model characterized SRS receipt, adjusting for patient age, dose, geographic location of treatment, facility type, and distance from treatment facility. RESULTS A total of 1,760 patients received GKRS, while 1,064 patients received LINAC SRS. Treatment at non-academic facilities was associated with increased LINAC SRS receipt, most prominently in the Midwestern (OR= 6.23; p< 0.001), Northeastern (OR= 4.42; p< 0.001), and Southern US (OR= 1.96;p< 0.001). Administered doses of 18–19 Gy (OR= 1.42;p= 0.025), 20–21 Gy (OR= 1.82;p< 0.001), and 22–24 Gy (OR= 3.11;p< 0.001) were associated with increased LINAC SRS receipt, as was patient location within 20 miles of a radiation treatment facility (OR= 1.27;p= 0.007). CONCLUSIONS Despite Gamma Knife being more prominently used over LINAC for SRS, patients treated at non-academic facilities outside of the Western US were substantially more likely to receive LINAC over Gamma Knife. Patients located in the Midwest were 523% more likely, Northeast 342% more likely, and South 96% more likely to receive LINAC when treated at a non-academic facility. Increasing dose independently predicted LINAC over GKRS, indicating that smaller tumors – particularly those less than two centimeters (consistent with RTOG 90-05 recommendations) – are being treated with LINAC. Finally, patients residing in close proximity to a treatment center were 27% more likely to receive LINAC, likely indicative of the increased geographic accessibility of LINAC compared with GKRS. These findings should result in hypothesis-generating questions to further explore predictors of LINAC versus GKRS.

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RTHP-06. IMPACT OF THE AMERICAN TAX PAYER RELIEF ACT ON STEREOTACTIC RADIOSURGERY UTILIZATION IN THE UNITED STATES

Neuro-Oncology ◽

10.1093/neuonc/noz175.879 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi211-vi211

Author(s):

Shearwood McClelland III ◽

Catherine Degnin ◽

Yiyi Chen ◽

Gordon Watson ◽

Jerry Jaboin

Keyword(s):

United States ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Gamma Knife ◽

The United States ◽

National Cancer Data Base ◽

Federal Law ◽

Cancer Data ◽

Whole Brain Radiation ◽

The Us

Abstract INTRODUCTION For brain metastases, single-fraction stereotactic radiosurgery (SRS) spares appropriately chosen patients from the invasiveness of operative intervention and the permanent cognitive morbidity of whole brain radiation. SRS is delivered predominantly via two modalities: Gamma Knife, and linear accelerator (LINAC). The implementation of the American Tax Payer Relief Act (ATRA) in 2013 represented the first time limitations specifically targeting SRS reimbursement were introduced into federal law. The subsequent impact of the ATRA on SRS utilization in the United States (US) has yet to be examined. METHODS The National Cancer Data Base (NCDB) from 2010–2016 identified brain metastases patients from non-small cell lung cancer (NSCLC) throughout the US having undergone SRS. Utilization between GKRS and LINAC was assessed before (2010–2012) versus after (2013–2016) ATRA implementation. Utilization was adjusted for several variables, including patient demographics and healthcare system characteristics. RESULTS From 2012 to 2013, there was a substantial decrease of LINAC SRS in favor of GKRS overall (37% to 28%) and individually in both academic and non-academic centers. Over the three-year span immediately preceding ATRA implementation, 65.8% received GKRS and the remaining 34.2% receiving LINAC. In the four years immediately following ATRA implementation 68.0% received GKRS compared with 32% receiving LINAC; these differences were not statistically significant. CONCLUSIONS ATRA implementation in 2013 caused an initial spike in Gamma Knife SRS utilization, followed by a steady decline, similar to rates prior to implementation. These findings are indicative that the ATRA provision mandating Medicare reduction of outpatient payment rates for Gamma Knife to be equivalent with those of LINAC SRS had a significant short-term impact on the radiosurgical treatment of metastatic brain disease throughout the US. Such findings should serve as a reminder of the importance and impact of public policy on treatment modality utilization by physicians and hospitals.

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RTHP-12. NATIONWIDE DISTRIBUTION OF LINEAR ACCELERATOR VERSUS GAMMA KNIFE STEREOTACTIC RADIOSURGERY UTILIZATION FOR METASTATIC BRAIN DISEASE IN ACADEMIC VERSUS COMMUNITY HOSPITALS

Neuro-Oncology ◽

10.1093/neuonc/noz175.885 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi212-vi212

Author(s):

Shearwood McClelland III ◽

Catherine Degnin ◽

Yiyi Chen ◽

Gordon Watson ◽

Jerry Jaboin

Keyword(s):

United States ◽

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Linear Accelerator ◽

The United States ◽

Brain Disease ◽

Treatment Modalities ◽

Academic Hospital ◽

Cancer Data ◽

Academic Hospitals

Abstract INTRODUCTION Single-fraction stereotactic radiosurgery (SRS) is often the preferred treatment modality for metastatic brain disease, particularly when patients have a small enough volume of disease to preclude whole brain radiation therapy and its associated permanent cognitive morbidity. The two predominant SRS treatment modalities are Gamma Knife and linear accelerator (LINAC). The recent impact of SRS modality in academic versus community hospital settings in the United States (US) since the 2013 implementation of the American Tax Payer Relief Act (ATRA) has yet to be examined. METHODS Brain metastases patients from non-small cell lung cancer (NSCLC) throughout the United States having undergone SRS were identified using the 2010–2016 National Cancer Data Base (NCDB). SRS utilization in academic versus community (non-academic) hospitals was identified and assessed. RESULTS Of the 4,012 SRS patients examined, the majority (64%) were treated at academic hospitals. Beginning in 2014, LINAC SRS rapidly increased in popularity compared to GKRS, reversing an annual decline in utilization originating from 2011. The 63% LINAC composition of SRS cases at non-academic centers in 2016 was an all-time high, a 12% increase from a year earlier. This was markedly different than SRS utilization at academic hospitals, where despite a steady increase in LINAC SRS since 2013, GKRS remained the predominant SRS modality, comprising 73% of cases in 2016. CONCLUSIONS The implementation of LINAC over Gamma Knife SRS in the non-academic hospital setting has markedly increased in the timespan since ATRA implementation, comprising more than 60% of SRS cases compared to only 27% of academic hospital SRS cases in 2016. These findings indicate that without the substantially increased Medicare reimbursement advantage formerly associated with Gamma Knife compared to LINAC prior to ATRA, the non-academic setting may be more sensitive than academic centers to conditions optimizing reimbursement.

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Shifts in Stereotactic Radiosurgery Platform Utilization for Brain Metastases in the United States

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2015.07.701 ◽

2015 ◽

Vol 93 (3) ◽

pp. E62

Author(s):

H.S.M. Park ◽

E.H. Wang ◽

C.E. Rutter ◽

C.D. Corso ◽

V.L. Chiang ◽

...

Keyword(s):

United States ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

The United States

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Gamma Knife versus Frameless Linear Accelerator Based Stereotactic Radiosurgery for Brain Metastases: Clinical Outcomes and Factors Associated with Local Failure and Radiation Necrosis

10.21203/rs.3.rs-885725/v1 ◽

2021 ◽

Author(s):

Gregory S. Alexander ◽

Jill S. Remick ◽

Emily S. Kowalski ◽

Kai Sun ◽

Yannick Poirer ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Clinical Outcomes ◽

Gamma Knife ◽

Linear Accelerator ◽

Radiation Necrosis ◽

Univariate Analysis ◽

Local Failure ◽

Rank Test ◽

Chi Square Analysis

Abstract BackgroundSingle-fraction stereotactic radiosurgery (SF-SRS) for the treatment of brain metastases can be delivered with either a Gamma-Knife platform (GK-SRS) or with a frameless linear accelerator (LA-SRS) which vary based on patterns of prescribing, patient setup and radiation delivery. Whether these differences affect clinical outcomes is unknown. MethodsPatients treated for metastatic brain cancer treated with SF-SRS from 2014-2020 were retrospectively reviewed and clinical outcomes were recorded on a per lesion basis. Covariates between groups were compared using a Chi-square analysis for dichotomous variables and t-test for continuous variables. Median follow up was calculated using the reverse Kaplan Meier (KM) method. Primary endpoints of local failure (LF) and symptomatic radiation necrosis (RN) were estimated using the KM method with salvage WBRT used as a censoring event. Outcome estimates were compared using the log-rank test. Multivariate analysis (MVA) and Cox proportional hazards modeling were used for statistical analyses. Propensity score (PS) adjustments were used to reduce the effects confounding variables.ResultsOverall, 119 patients with 287 lesions were included for analysis which included 57 patients (127 lesions) treated with LA-SRS compared to 62 patients (160 lesions) treated with GK-SRS. On both multivariate and univariate analysis, there was no statistically significant differences between GK-SRS and LA-SRS for LF, RN, or the combined endpoint of either LF or RN (multivariate p-value=0.17).ConclusionsIn our retrospective cohort, we found no statistically significant differences in the incidence of RN or LF in patients treated with GK-SRS when compared to LA-SRS.Trial Registration: Retrospectively registered

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Stereotactic Radiosurgery Practice Patterns for Brain Metastases in the United States: A National Survey

JHN Journal ◽

10.29046/jhnj.013.1.006 ◽

2018 ◽

Vol 13 (1) ◽

Author(s):

Erik Blomain ◽

Hyun Kim ◽

Shivank Garg ◽

Deepak Bhamidipati ◽

Jenny Guo ◽

...

Keyword(s):

United States ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

National Survey ◽

Practice Patterns ◽

The United States

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Interrupted Time-Series for the Evaluation of Affordable Care Act Impact on Stereotactic Radiosurgery for the Treatment of Brain Metastases

10.21203/rs.3.rs-147005/v1 ◽

2021 ◽

Author(s):

Hind Beydoun ◽

Shuyan Huang ◽

May Beydoun ◽

Shaker Eid ◽

Alan Zonderman

Keyword(s):

United States ◽

Time Series ◽

Radiation Therapy ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Affordable Care Act ◽

Interrupted Time Series ◽

The United States ◽

Over Time ◽

Hospital Characteristics

Abstract Background: The 2010 Affordable Care Act aimed at reducing healthcare costs, improving healthcare quality and expanding health insurance coverage among uninsured individuals in the United States. We examined trends in utilization of radiation therapies and stereotactic radiosurgery before and after its implementation among U.S. adults hospitalized with brain metastasis.Methods: Interrupted time-series analyses of data on 383934 2005-2014 Nationwide Inpatient Sample hospitalizations were performed, whereby yearly and quarterly cross-sectional data were evaluated and Affordable Care Act implementation was considered the main exposure variable, stratifying by patient and hospital characteristics. Results: We observed consistently declining trends in radiation therapy over time and post-Affordable Care Act status with variability in level of utilization among specific sub-groups. Stereotactic radiosurgery prevalence increased over time among Hispanics, elective admissions, Midwestern hospitals, non-teaching hospitals and hospitals with medium bed size. Post-Affordable Care Act was associated with increased stereotactic radiosurgery prevalence among African-Americans, non-elective and weekend admissions, with changes in slope in the context of weekend admissions and hospitals with large bed size. Conclusions: Whereas hospitalized adults in the United States utilized less radiation therapy and slightly more stereotactic radiosurgery over the ten-year period, utilization levels and trends were not consistent among distinct sub-groups defined by patient and hospital characteristics, with some traditionally underserved populations more likely to receive healthcare services post-Affordable Care Act implementation. The Affordable Care Act may be helpful at reducing the need for radiation therapy and closing the gap in access to technological advances such as stereotactic radiosurgery for treating brain metastases.

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