Rich Benjamin J, Almeida Timoteo, Maas Jared A, Mehta Shahil, Singh Raj, Perlow Haley K, Silver Benjamin, Lehrer Eric J, Soni Yash, Jin William H, Seldon Crystal S, Azzam Gregory, Yechieli Raphael, Kubicek Gregory, Komotar Ricardo J, Benjamin Carolina G, Diwanji Tejan, Mellon Eric A
Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
J Radiosurg SBRT. 2024;9(2):101-111.
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.
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.
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).
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.
接受立体定向放射外科治疗（SRS）的脑转移瘤患者的经历可能会影响其对挽救性治疗的态度。此外，医生对挽救性治疗的态度可能因专业和经验而异。我们的目的是比较医生对SRS的态度和患者的经历。
2021年11月至2022年11月期间，在一家机构对符合条件的、在明确诊断或术后接受了一个疗程的SRS或分次立体定向放射治疗（FSRT）且未接受全脑放疗（WBRT）的脑转移瘤患者进行调查，了解他们对挽救性治疗的看法。另外，向美国其他七家学术机构的住院医师、研究员和主治医师发放了一份包含11个问题的多学科医生调查问卷。采用卡方检验和曼-惠特尼U检验来评估差异。
共调查了30名患者和88名医生。大多数患者表示对初始SRS/FSRT感到满意或非常满意（90%）。当在WBRT和SRS之间选择挽救性治疗时，所有患者都倾向于SRS。医生包括放射肿瘤学家（69.3%）、神经外科医生（19.3%）、医学肿瘤学家（8.0%）和神经肿瘤学家（3.4%）。大多数医生对自己讨论SRS治疗脑转移瘤的风险和益处的能力有信心或非常有信心（78.9%），但如果患者之前接受过SRS，这一比例会显著降低（56.6%，P<0.001）。在这些情况下，不同医学专业的反应和信心水平存在显著差异（P<0.05）。
患者和医生认为，在脑转移瘤初始SRS治疗后，肿瘤控制以及长期毒性是挽救性治疗最重要的因素。
