Rupesh Kotecha, MD
Brain metastases are a significant and growing healthcare burden. With the growth and aging of populations worldwide, the global cancer burden is expected to increase to nearly 22 million by 2030, at which time cancer will be the leading cause of death in the United States.1,2
Large-scale studies of brain metastases are lacking, but reported percentages of patients with systemic disease who develop brain metastases range from 9% to 50%.3
The cost of treating brain metastases is also rising. The growth in the incidence and cost of treating brain metastases creates a critical challenge for physicians and cancer care centers: how to optimize and ensure access to high-quality care to improve patient quality of life and survival while simultaneously implementing cost-effective clinical workflows and processes.
, SRS is currently being used in single-session, hypofractionated, and multisession (staged) regimens, depending on the clinical scenario. Single-session regimens can be used to treat lesions up to 3 cm in diameter and offer patients the greatest convenience. Hypofractionated regimens are the most versatile and can be used across the greatest range of lesion size. Although lesions greater than 3 cm are usually treated with multisession SRS administered over several weeks, Miami Cancer Institute in Kendall, Florida, has successfully used hypofractionated regimens in these cases for improved patient convenience. Regardless of regimen, dose reduction is performed for lesions in specific locations, such as those in the brainstem or in proximity to the optic pathway.
Table. Miami Cancer Institute Brain Metastases SRS Guidelines4
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