Spinal stereotactic body radiotherapy in the United States: A decade-long nationwide analysis of patient demographics, practice patterns, and trends over time

Shearwood McClelland, Ellen Kim, Peter G. Passias, James D. Murphy, Albert Attia, Jerry Jaboin

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Nationwide utilization of spinal stereotactic body radiotherapy (SBRT) is not known; to address this void, the National Cancer Data Base (NCDB) from 2004 to 2013 was used for analysis. Spinal SBRT was defined as 1-5 fractions (14-32. Gy) delivered to the cervical, thoracic, lumbar or sacral spine. From 2004 to 2013, 1044 patients received spinal SBRT, most commonly in single-fraction (38%), three-fraction (26%) and five-fractions (25%). Metastatic spinal disease most commonly originated from the lung (34%), kidney (14%), and blood (9%). The most common insurance status receiving spinal SBRT was private (44%) followed by Medicare (43%), with Medicaid (8%) a distant third. Fifty-six percent of patients were male, and 55% of patients were younger than age 65. 80% of patients were Caucasian, with 13% being African-American. The vast majority (74%) of patients had no Charlson/Deyo comorbidities. The incidence of spinal SBRT gradually increased over time, rising from 2% to 20% of cases from 2004 to 2013. Comprising only 1.4% of spinal metastases radiation in 2004, SBRT rose to a 5.8% share in 2013. In conclusion, SBRT for spine metastases in the United States has more than quadrupled in utilization over a recent ten-year span. Although the majority of spinal SBRT is multi-fraction, the most popular fractionation scheme was single-fraction. It has been most commonly used for Caucasian men under age 65 with private/Medicare insurance and no comorbidities. By far the most common origin of spinal metastases treated by SBRT was the lung, followed by renal cancer. These results provide a baseline for further prospective investigation.

Original languageEnglish (US)
JournalJournal of Clinical Neuroscience
DOIs
StateAccepted/In press - 2017

Fingerprint

Radiosurgery
Demography
Neoplasm Metastasis
Medicare
Comorbidity
Spine
Spinal Diseases
Lung
Insurance Coverage
Kidney Neoplasms
Medicaid
Insurance
African Americans
Thorax
Databases
Radiation
Kidney
Incidence

Keywords

  • National Cancer Data Base
  • Nationwide trends
  • Spine
  • Stereotactic body radiotherapy
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Spinal stereotactic body radiotherapy in the United States : A decade-long nationwide analysis of patient demographics, practice patterns, and trends over time. / McClelland, Shearwood; Kim, Ellen; Passias, Peter G.; Murphy, James D.; Attia, Albert; Jaboin, Jerry.

In: Journal of Clinical Neuroscience, 2017.

Research output: Contribution to journalArticle

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title = "Spinal stereotactic body radiotherapy in the United States: A decade-long nationwide analysis of patient demographics, practice patterns, and trends over time",
abstract = "Nationwide utilization of spinal stereotactic body radiotherapy (SBRT) is not known; to address this void, the National Cancer Data Base (NCDB) from 2004 to 2013 was used for analysis. Spinal SBRT was defined as 1-5 fractions (14-32. Gy) delivered to the cervical, thoracic, lumbar or sacral spine. From 2004 to 2013, 1044 patients received spinal SBRT, most commonly in single-fraction (38{\%}), three-fraction (26{\%}) and five-fractions (25{\%}). Metastatic spinal disease most commonly originated from the lung (34{\%}), kidney (14{\%}), and blood (9{\%}). The most common insurance status receiving spinal SBRT was private (44{\%}) followed by Medicare (43{\%}), with Medicaid (8{\%}) a distant third. Fifty-six percent of patients were male, and 55{\%} of patients were younger than age 65. 80{\%} of patients were Caucasian, with 13{\%} being African-American. The vast majority (74{\%}) of patients had no Charlson/Deyo comorbidities. The incidence of spinal SBRT gradually increased over time, rising from 2{\%} to 20{\%} of cases from 2004 to 2013. Comprising only 1.4{\%} of spinal metastases radiation in 2004, SBRT rose to a 5.8{\%} share in 2013. In conclusion, SBRT for spine metastases in the United States has more than quadrupled in utilization over a recent ten-year span. Although the majority of spinal SBRT is multi-fraction, the most popular fractionation scheme was single-fraction. It has been most commonly used for Caucasian men under age 65 with private/Medicare insurance and no comorbidities. By far the most common origin of spinal metastases treated by SBRT was the lung, followed by renal cancer. These results provide a baseline for further prospective investigation.",
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