Practice patterns for the management of patients with more than 3 brain metastases appear to vary widely among radiation oncologists, according to a study published in Cancer.1

Published guidelines established the optimal treatment strategies for patients with up to 3 to 4 brain metastases, but with stereotactic radiosurgery (SRS) delivery techniques improving, use of SRS for those with more than 3 metastases is increasing.

For this study, researchers surveyed more than 5000 practicing radiation oncologists, of which 711 responded. Questions included the ideal cutoff number at which clinicians would switch from using SRS to whole-brain radiotherapy and which group of patients presents the greatest challenge.

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Specialists in treating central nervous system (CNS) tumors were more likely to treat patients with brain metastases with SRS, though there was a significant difference of opinion in the optimal cut-off for the number of lesions to treat with SRS instead of whole-brain radiotherapy.

CNS specialists who saw 10 or more patients per month were more likely to reserve SRS for patients with about 8 lesions, while CNS specialists treating 5 to 9 patients per month and non-CNS specialists used SRS for patients with 5 to 6 brain lesions.

More than half of radiation oncologists said that patients with 4 to 6 brain metastases are the most challenging subpopulation to treat, suggesting that clinicians struggle with treating patients with a moderate intracranial disease burden.

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The findings demonstrate that radiation oncologists, particularly high-volume CNS specialists, are treating significantly more brain metastases with SRS than what is recommended by consensus guidelines. Further prospective studies are warranted to confirm the practice patterns observed in this study.


  1. Sandler KA, Shaverdian N, Cook RR, et al. Treatment trends for patients with brain metastases: Does practice reflect the data? Cancer. 2017 Feb 8. doi: 10.1002/cncr.30607 [Epub ahead of print]