title: Physician self-reported treatment of brain metastases according to patients' clinical and demographic factors and physician practice setting.
abstract: BACKGROUND
  Limited data guide radiotherapy choices for patients with brain metastases. This survey aimed to identify patient, physician, and practice setting variables associated with reported preferences for different treatment techniques.
  
  
  METHODS
  277 members of the American Society for Radiation Oncology (6% of surveyed physicians) completed a survey regarding treatment preferences for 21 hypothetical patients with brain metastases. Treatment choices included combinations of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and surgery. Vignettes varied histology, extracranial disease status, Karnofsky Performance Status (KPS), presence of neurologic deficits, lesion size and number. Multivariate generalized estimating equation regression models were used to estimate odds ratios.
  
  
  RESULTS
  For a hypothetical patient with 3 lesions or 8 lesions, 21% and 91% of physicians, respectively, chose WBRT alone, compared with 1% selecting WBRT alone for a patient with 1 lesion. 51% chose WBRT alone for a patient with active extracranial disease or KPS=50%. 40% chose SRS alone for an 80 year-old patient with 1 lesion, compared to 29% for a 55 year-old patient. Multivariate modeling detailed factors associated with SRS use, including availability of SRS within one's practice (OR 2.22, 95% CI 1.46-3.37).
  
  
  CONCLUSIONS
  Poor prognostic factors, such as advanced age, poor performance status, or active extracranial disease, correspond with an increase in physicians' reported preference for using WBRT. When controlling for clinical factors, equipment access was independently associated with choice of SRS. The large variability in preferences suggests that more information about the relative harms and benefits of these options is needed to guide decision-making.
authors.affiliation: Department of Radiation Oncology, Georgetown University Medical Center, 3800 Reservoir Road, Washington, D,C, USA. Marie-Adele.S.Kress@gunet.georgetown.edu
authors.forename: Marie-Adele S
authors.initials: MA
authors.lastname: Kress
authors.forename: Naren
authors.initials: N
authors.lastname: Ramakrishna
authors.forename: Solomon B
authors.initials: SB
authors.lastname: Makgoeng
authors.forename: Keith R
authors.initials: KR
authors.lastname: Unger
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002755:Choice Behavior / Q000502:physiology; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D016371:Cranial Irradiation / Q000706:statistics & numerical data; D003625:Data Collection; D003710:Demography; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods / Q000706:statistics & numerical data; D018579:Patient Selection; D010820:Physicians / Q000706:statistics & numerical data; D011364:Professional Practice / Q000706:statistics & numerical data*; D011365:Professional Practice Location / Q000191:economics / Q000706:statistics & numerical data*; D016634:Radiosurgery / Q000706:statistics & numerical data; D057566:Self Report; D012959:Socioeconomic Factors