Table 4.

Treatment Recommendation

Variable	1 CM	2-4 CMs	≥ 5 CMsa	NA	No. of Patients	%
Total	541	325	165	17	1048	100.0
Specialist intervention	365	158	28	0	551	52.6
• Surgical resection alone	163	31	2		196	18.7
• Surgical resection + SRS	8	27	2		37	3.5
• Surgical resection + SRS + cavity SRS	0	2	0		2	< 0.2
• Surgical resection + cavity SRS	21	0	0		21	2.0
• Surgical resection + chemotherapy/immunotherapy	4	2	0		6	0.6
• Surgical resection + WBRT/local fx Rx	12	5	1		18	1.7
• Surgical resection + CSF diversion	1	2	1		4	0.4
• SRS alone	126	74	18		218	20.8
• SRS + WBRT/local fx Rx	3	1	1		5	0.5
• SRS + chemotherapy/immunotherapy	14	5	1		20	1.9
• Biopsy alone	8	3	0		11	1.0
• Biopsy + SRS	0	1	0		1	< 0.1
• CSF diversion	5	2	2		9	0.9
• Clinic assessment to discuss surgery/SRS	0	3	0		3	< 0.3
Nonspecialist treatment only	165	147	133	1	447	42.7
• Chemotherapy	8	4	6		18	1.7
• Immunotherapy	3	2	3		8	0.8
• WBRT	20	40	54b	1	115	11.0
• Local fx Rx	11	4	1		16	1.5
• Oncology treatment NOS	13	22	14		49	4.7
• Best supportive care	68	62	50c		180	17.2
• Reimaging/surveillance	29	7	3		39	3.7
• Referral to other specialty	13	6	2		22	2.1
No MDT decision	11	20	4	16	51	4.9
• NA					45	4.3
• Indeterminate					6	0.6
Delay in MDT decision
• Yes					195	18.6
• No					767	73.2
• NA					86	8.2
Reason for delay (multiple)
• Imaging not available					102	52.3
• Insufficient information					53	27.2
• Awaiting further investigations/results					27	13.8
• Cancellation					2	< 0.2
• Wrong MDT					15	7.7
• Intentional delay					9	4.6
• Assessment					8	4.1
• Other					7	3.6

Abbreviations: CM, cerebral metastasis; CSF, cerebrospinal fluid; local fx Rx, local fractionated radiotherapy; MDT, multidisciplinary team meeting; NA, not available (unknown or not recorded); NOS, not otherwise specified (either WBRT or chemotherapy/immunotherapy or best supportive care); SRS, stereotactic radiosurgery; WBRT, whole-brain radiation therapy.

^aIncludes patients with leptomeningeal disease (LMD), n = 3.

^bIncludes n = 1 with LMD.

^cIncludes n = 2 with LMD.