Evidence map›Paper›PMID 40844729›Full record

ArticleJournal of neuro-oncology2025

Stereotactic radiosurgery for brain metastases: evolving practice patterns from the national cancer database (2004-2020).

Jonathan J Shih, Bhav Jain, Rohan Patel, Urvish Jain, Miranda Lam, Fumiko Chino, Manali I Patel, Edward Christopher Dee, Erqi Pollom, Gordon Li and 1 more

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In one paragraph

Article in Journal of neuro-oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jonathan J ShihSchool of Medicine, University of California, San Francisco, San Francisco, CA, USA. jonathan.shih@ucsf.edu.
Bhav JainSchool of Medicine, Stanford University, Stanford, CA, USA.
Rohan PatelDepartment of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
Urvish JainSchool of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Miranda LamDepartment of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Fumiko ChinoDepartment of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.
Manali I PatelDepartment of Medicine, Stanford Medicine, Stanford, CA, USA.
Edward Christopher DeeDepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Erqi PollomDepartment of Radiation Oncology, Stanford Medicine, Stanford, CA, USA.
Gordon LiDepartment of Neurosurgery, Stanford Medical, Palo Alto, CA, USA.
Kekoa TaparraDepartment of Radiation Oncology, Stanford Medicine, Stanford, CA, USA.

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI SELWYN M VICKERS · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

purposeStereotactic radiosurgery (SRS) offers less neurotoxicity and comparable survival to whole-brain radiation therapy (WBRT) for brain metastases (BM). Current SRS practice patterns are understudied. We examined national trends in SRS and WBRT utilization.

methodsWe queried the National Cancer Database for patients with BM from twelve cancers (≥ 18 years; diagnosed 2004–2020) treated with radiotherapy. Patients were grouped by first-course radiotherapy modality (SRS:1–5 fractions; WBRT:5–15 fractions). Multivariable logistic regression assessed SRS predictors, adjusting for sociodemographic and clinical variables. A race*diagnosis year interaction evaluated temporal trends. Difference-in-differences analysis assessed Medicaid expansion impact.

resultsOf 89,984 patients, 24,174 (27%) received SRS. SRS utilization rose from 8 to 54% between 2004 and 2020 (P < 0.001). SRS was more likely in patients diagnosed in recent years (aOR = 3.85 [95% CI = 3.70–4.01]), who received prior chemotherapy (aOR = 1.17 [1.13–1.21]) or surgery (aOR = 2.25 [2.11–2.40]), and those with colorectal (aOR = 1.93 [1.64–2.26]), lung (aOR = 1.37 [1.24–1.50]), melanoma (aOR = 2.76 [2.46–3.10]), thyroid (aOR = 2.17 [1.36–3.46]), or kidney/bladder cancer (aOR = 2.76 [2.44–3.12]) versus breast cancer. SRS was less likely in patients with lower income (aOR = 0.88 [0.85–0.92]) or educational attainment (aOR = 0.88 [0.85–0.92]), Medicaid/Medicare (aOR = 0.86 [0.83–0.90]), no insurance (aOR = 0.49 [0.44–0.53]), or treatment at community (aOR = 0.31 [0.29–0.34]), comprehensive community (aOR = 0.56 [0.54–0.58]), or integrated facilities (aOR = 0.77 [0.73–0.80]). Race and ethnicity were not overall associated with SRS use. Medicaid expansion had no impact (aOR = 0.99 [0.88–1.10]).

conclusionsSRS utilization increased between 2004 and 2020. However, disparities persist for patients with lower socioeconomic status, uninsured/public insurance, or non-academic center treatment, potentially reflecting access disparities or differences in disease burden. Targeted efforts are needed to ensure equitable access to advanced cancer therapies, particularly in the context of potential additive effects of disparities in disease burden.

Indexed as

Brain NeoplasmsCranial IrradiationPractice Patterns, Physicians'RadiosurgeryAdultAgedDatabases, FactualFemaleHumansMaleMiddle AgedUnited StatesBrain Neoplasms / secondaryHealthcare disparitiesRadiotherapy / trendsSocioeconomic factorsStereotactic radiosurgeryWhole brain radiation therapy

Identifiers

PMID40844729
PMCPMC12511135

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.