Table 1.
Survey questions and responses. Listing of the 18 survey questions with associated responses. Responses are percentages for discrete answers, and rating averages for rank-order questions
| Question | Responses (Raw Numbers) | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| 1. Do you treat patients with brain metastases with SRS? | Yes 71.3% (72) |
No 28.7% (29) |
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| 2. How many years have you been a practicing radiation oncologist? | < 5 yrs 22.5% (16) |
26.8% (19) | 5-10 yrs 22.5% (16) |
28.2% (20) | 11-20 yrs | > 20 yrs | |||
| 3. What are the primary disease sites you treat? Choose as many as applicable. | Lung 49.3% (35) |
CNS 66.2% (47) |
GU 26.8% (19) |
Breast 26.8% (19) |
H&N 38% (27) |
GI 28.2% (20) |
Peds 12.7% (9) |
GYN 11.3% (8) |
|
| 4. Which modality do you more commonly prescribe for < 10 brain metastases? | SRS > WBRT 73.7% (42) |
10.5% (6) | 15.8% (7) | WBRT > SRS | SRS = WBRT | ||||
| 5. Which modality do you more commonly prescribe for > = 10 brain metastases? | SRS > WBRT 5.3% (3) |
82.5% (47) | 12.3% (7) | WBRT > SRS | SRS = WBRT | ||||
| 6. How have you changed your management of patients with multiple brain metastases in the past 5 years? Check all that apply. | I more frequently use SRS without WBRT I more frequently use SRS without WBRT | 84.2% (48) | |||||||
| I more frequently use WBRT without SRS I more frequently use WBRT without SRS |
0% (0) | ||||||||
| The number of brain metastases I am willing to treat with SRS alone has increased The number of brain metastases I am willing to treat with SRS alone has decreased The size of brain metastases I am will to treat with SRS alone has increased The size of brain metastases I am will to treat with SRS alone has decreased My management of patients with multiple brain metastases has not changed |
82.5% (47) 3.5% (2) 19.3% (11) 5.3% (3) 5.3% (3) |
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| 7. What is the maximum number of brain metastases you would commonly treat with upfront SRS without offering WBRT? | 1-4 40.4% (23) |
5-10 42.1% (24) |
11-15 7% (4) |
16-20 7% (4) |
No Limit 3.5% (2) |
No SRS without WBRT 0% (0) |
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| 8. Rank the following criteria by weight (first being most important) in determining the use of SRS vs WBRT at initial presentation (57 responses) | Diameter of metastases Number of metastases Volume of metastases Histology Performance status Status of extracranial disease Location (critical structures) |
3.96 2.37 4.04 4.81 3.23 4.33 5.26 |
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| 9. Which of the following do you consider a contraindication to SRS without WBRT (not including size and number of metastases)? | Leptomeningeal disease Portion of brain stem involved Near or involving optic apparatus Local recurrence after prior SRS Intracranial progression after prior SRS Systemic disease progression 2-4 |
5-10 | 11-15 | 93% (53) 17.5% (10) 43.9% (25) 21.1% (12) 7% (4) 14.0% (8) 16-20 |
No Limit | ||||
| 10. What is the maximum number of simultaneous metastases you are willing to treat with SRS in one session? | 31.6% (18) | 40.4% (23) | 15.8% (9) | 7% (4) | 5.3% (3) | ||||
| 11. What is the maximum number of simultaneous metastases you are willing to treat with SRS over multiple sessions? | 2-4 12.3% (7) |
5-10 43.9% (25) |
11-15 10.5% (6) |
16-20 14% (8) |
No Limit 19.3% (11) |
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| 12. What margin do you prescribe for SRS? | 0 mm 49.1% (28) |
1 mm 38.6% (22) |
2 mm 12.3% (7) |
3 mm 0% (0) |
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| 13. Which factors do you consider in your evaluation of an SRS plan for a lesion that is not near critical structures? Check all that apply. | Brain V12 61.4% (35) |
Conformity Index 84.2% (48) |
Mean brain dose/integral dose 36.8% (21) |
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| 14. Rank the following criteria by weight (first being most important) in your determining radiation dose for a single brain metastasis without prior WBRT (57 responses). | Diameter 1.54 |
Volume 1.68 |
Histology 2.77 |
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| 15. How do you generally prescribe your SRS dose for multiple brain metastases (> = 4)? | Based on size/volume only Based on uniform dose, such as 18 Gy or 20 Gy Based on size/volume, but reduced as compared to single brain metastasis Reduced dose based on V12 or other parameters I do not routinely treat > = 4 brain metastases simultaneously |
54.4% (31) 8.8% (5) 19.3% (11) 3.5% (2) 14% (8) |
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| 16. What is the primary modality you use to treat intracranial metastases? | Gamma Knife 31.6% (18) |
LINAC 54.4% (31) |
CyberKnife 14.0% (8) |
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| 17. If you use a LINAC based system, do you use a mono-isocenter technique for patients with multiple brain metastases? | Yes 43.9% (25) |
No 26.3% (15) |
N/A 29.8% (17) |
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| 18. Does your department have a policy for the treatment of brain metastases? | Yes 35.1% (20) |
No 64.9% (37) |
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