Disparities in the use of stereotactic radiosurgery for the treatment of lung cancer brain metastases: a SEER-Medicare study

  • Mustafa S. Ascha
  • Kaitlyn Funk
  • Andrew E. Sloan
  • Carol Kruchko
  • Jill S. Barnholtz-SloanEmail author
Research Paper


Stereotactic radiosurgery (SRS) is a costly procedure used to irradiate disease tissue while sparing healthy tissue, ideally limiting the side effects of treatment. SRS is frequently used in the setting of lung cancer, which is associated with greater rates of BM, though its cost may lead to potentially inequitable use across patient populations. This study investigates potential disparities in the use of SRS to treat Medicare patients. Surveillance, Epidemiology, and End-Results cancer registry data for patients diagnosed between the years 2010 and 2012 were examined to identify lung cancer patients diagnosed with BM at the same time as their primary cancer (SBM). Medicare claims for SRS were identified; the odds of having SRS claims and hazards of mortality associated with those odds were examined with respect to various clinical and demographic characteristics. Of 74,142 Medicare-enrolled patients diagnosed with lung cancer, 9192 were diagnosed with SBM and 3259 of those patients received SRS. Adjusting for clinical and demographic characteristics, males with SBM had 0.85 times the odds of SRS compared to females with SBM. Black patients and those of other race had significantly lower odds of evidence of SRS compared to WNH patients. SRS may not be delivered equitably among Medicare patients. Males and minority patients may have decreased odds of SRS and worse survival compared to female and WNH patients, respectively.


Lung cancer brain metastases Stereotactic radiosurgery SEER-Medicare Observational study Real-world evidence 



American Indian


American Joint Committee on Cancer


Anaplastic lymphoma kinase


Asian/Pacific Islander


Brain metastases


Central Brain Tumor Registry of the United States


Centers for Disease Control and Prevention


Centers for Medicare and Medicaid Services


Epidermal growth factor receptor


Information Management Services Inc


National Cancer Database


National Cancer Institute


National Home Infusion Association


Non-small cell lung cancer


Synchronous brain metastases


Small cell lung cancer


Surveillance, Epidemiology, and End Results Program


Stereotactic radiosurgery


White Non-Hispanic



Funding for the Central Brain Tumor Registry of the United States (CBTRUS) has been provided by the Centers for Disease Control and Prevention (CDC) under Contract No. 2016-M-9030, the American Brain Tumor Association, The Sontag Foundation, Novocure, AbbVie, the Musella Foundation, National Brain Tumor Society, the National Cancer Institute (NCI) under Contract No. HHSN261201800176P, the Zelda Dorin Tetenbaum Memorial Fund, the Uncle Kory Foundation, and from private and in kind donations. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC or NCI. This work made use of the High Performance Computing Resource in the Core Facility for Advanced Research Computing at Case Western Reserve University. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. Funding was provided by Foundation for the National Institutes of Health (Grant No. CA217956).


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Population and Quantitative Health Sciences, Center for Clinical InvestigationCase Western Reserve University School of MedicineClevelandUSA
  2. 2.Case Western Reserve UniversityClevelandUSA
  3. 3.Department of NeurosurgeryUniversity Hospitals Cleveland Medical CenterClevelandUSA
  4. 4.Central Brain Tumor Registry of the United StatesHinsdaleUSA
  5. 5.Department of Population and Quantitative Health Sciences, Case Comprehensive Cancer Center, Institute for Computational BiologyCase Western Reserve University School of MedicineClevelandUSA

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