Purpose: In the United States, brain metastases (BMs) affect 10% to 20% of patients with cancer, presenting a significant health care challenge and necessitating intricate, high-cost treatments. Few studies have explored the comprehensive care cost for BMs, and none have used real insurance claims data. Partnering with a northeastern health care insurer, we investigated the true costs of various brain-directed radiation methods, aiming to shed light on treatment expenses, modalities, and their efficacy. Methods and Materials: We analyzed medical claims from Highmark Health-insured patients in Pennsylvania, Delware, West Virginia, and New York diagnosed with BMs (ICD-10 code C79.31) and treated with radiation from January 1, 2020 to July 1, 2022. Costs for radiation techniques were grouped by specific current procedural terminology claim codes. We subdivided costs into technical and physician components and separated hospital from freestanding costs for some modalities. Results: From January 1, 2020 to July 1, 2022, 1048 Highmark Health members underwent treatment for BMs. Females (n = 592) significantly outnumbered males (n = 456), with an average age of 64.4 years. Each member had, on average, 5.309 claims costing $2015 per claim. Total cost totaled $10,697,749. Per-treatment analysis showed that hippocampal avoidance intensity modulated radiation therapy was the costliest treatment at $47,748, followed by stereotactic radiation therapy at $37,230, linear accelerator stereotactic radiosurgery (SRS) at $30,737, Gamma Knife SRS at $30,711, and whole-brain radiation therapy at $5225. Conclusions: Whole-brain radiation therapy was the least costly radiation technique. Similar per-treatment prices for Gamma Knife and linear accelerator SRS support their use in treating BMs. Stereotactic radiation therapy in general was costlier on a per-use basis than SRS, prompting further scrutiny on its frequent use. Hippocampal avoidance intensity modulated radiation therapy was the costliest radiation therapy on a per-use basis by a moderate amount, prompting further discussion about its comparative cost effectiveness against other radiation modalities. This study underscores the importance of multiple considerations in treating BMs, such as tumor control, survival, side effects, and costs.
OBJECTIVE: Stereotactic radiosurgery (SRS) is used for the treatment of residual/recurrent nonfunctional pituitary adenoma (NFPA). The aim of this study was to evaluate the factors related to long-term tumor control and delayed endocrinopathies following SRS. METHODS: This retrospective, multicenter study included patients with recurrent/residual NFPA treated with single-fraction SRS; they were then divided into two arms. The first arm included patients with at least 5 years of radiographic follow-up and all patients with local tumor progression. The second arm included patients with at least 5 years of endocrinological follow-up and all patients who developed endocrinopathy. Study endpoints were tumor control and new or worsening hypopituitarism after SRS and were analyzed using Cox regression and Kaplan-Meier methodology. RESULTS: There were 360 patients in the tumor control arm (median age 52.7 [IQR 42.9-61] years, 193 [53.6%] males) and 351 patients in the hypopituitarism arm (median age 52.5 [IQR 43-61] years, 186 [53.0%] males). The median follow-up in the tumor control evaluation group was 7.95 (IQR 5.7-10.5) years. Tumor control rates at 5, 8, 10, and 15 years were 93% (95% CI 90%-95%), 87% (95% CI 83%-91%), 86% (95% CI 82%-90%), and 69% (95% CI 59%-81%), respectively. The median follow-up in the endocrinopathy evaluation group was 8 (IQR 5.9-10.7) years. Pituitary function preservation rates at 5, 8, 10, and 15 years were 83% (95% CI 80%-87%), 81% (95% CI 77%-85%), 78% (95% CI 74%-83%), and 71% (95% CI 63%-79%), respectively. A margin dose > 15 Gy (HR 0.8, 95% CI 0.7-0.9; p < 0.001) and a delay from last resection to SRS > 1 year (HR 0.9, 95% CI 0.7-0.9; p = 0.04) were significant factors related to tumor control in multivariable analysis. A maximum dose to the pituitary stalk ≤ 10 Gy (HR 1.1, 95% CI 1.09-1.2; p < 0.001) was associated with pituitary function preservation. New visual deficits after SRS occurred in 7 (1.94%) patients in the tumor control group and 8 (2.3%) patients in the endocrinopathy group. Other new cranial nerve deficits post-SRS occurred in 4 of 160 patients with data in the tumor control group and 3 of 140 patients with data in the endocrinopathy group. CONCLUSIONS: SRS affords favorable and durable tumor control for the vast majority of NFPAs. Post-SRS hypopituitarism occurs in a minority of patients, but this risk increases with time and warrants long-term follow-up.
Aim: We utilized the National Cancer Database to describe the treatment trends in brain metastases from primary testicular cancers. Methods: We analyzed data from the NCDB from 2010 to 2015 for patients with both primary testicular cancers and brain metastases who were treated with brain-directed radiation. We performed multivariable logistic and cox regressions to identify predictors of treatment type and overall survival respectively. Results: Most patients meeting the above criteria received whole brain radiation therapy as opposed to stereotactic radiosurgery (SRS). Predictors of improved survival were age, private insurance coverage, receipt of chemotherapy, and receipt of SRS. The 5-year survival rate was highest for patients who received SRS. Conclusion: This study confirms significantly improved overall survival with the use of SRS.
Testicular cancer is quite rare, making up just 1% of solid cancers found in men every year. Even rarer is the situation where this cancer spreads to the brain. When this happens, it can be treated in a few different ways: surgery, radiation to the entire brain, a focused type of radiation called stereotactic radiosurgery, or a combination of these methods. Due to its rarity, there isn't a clear-cut best approach for treating these brain tumors. In our research, we used a massive database, the National Cancer Database (NCDB), to get a clearer picture of this issue. We looked at patients diagnosed with testicular cancer between 2004 and 2015 who also had at least one tumor in the brain. By analyzing this information, we could compare the survival outcomes of patients based on the type of treatment they received and other factors. We found that brain tumors from testicular cancer are very rare, found in just 0.4% of the patients we studied. We also found that treatment with either focused radiation, whole brain radiation, or chemotherapy significantly improves survival rates compared with no treatment. In addition, focused radiation, called stereotactic radiosurgery, might result in even better survival results than radiation to the entire brain. Receiving this focused radiation was more common in patients who also had tumors in other parts of their body. While our study gives essential insights, it does have some limitations. The database we used doesn't provide specific details like the size of the brain tumors, the exact treatment doses, and some other crucial patient information. This means that while we now have a better overall picture, more research is needed to give patients and doctors a complete understanding.
Brain Neoplasms , Radiosurgery , Testicular Neoplasms , Male , Humans , United States , Testicular Neoplasms/surgery , Retrospective Studies , Brain Neoplasms/secondary
