Radiotherapy Utilization Patterns Among Patients With Metastatic Renal Cell Carcinoma of the Spine: A National Claims...

Area of Science:

• Oncology
• Radiation Oncology
• Health Services Research

Background:

• Spinal metastases from renal cell carcinoma (RCC) present a significant clinical challenge.
• Stereotactic body radiation therapy (SBRT) offers a precise, high-dose radiation option for these lesions.
• Understanding patterns of care and predictors of SBRT use is crucial for optimizing treatment delivery.

Purpose of the Study:

• To identify sociodemographic factors associated with the utilization of SBRT for spinal metastatic RCC.
• To analyze temporal trends in first-line SBRT use in relation to National Comprehensive Cancer Network (NCCN) guideline updates.
• To investigate potential disparities in SBRT access and utilization.

Main Methods:

• Retrospective analysis of the PearlDiver Database (2010-2023) for adult patients with spinal mRCC.
• Categorization of patients into SBRT and conventional external beam radiation therapy (EBRT) cohorts based on first-line radiotherapy.
• Statistical comparison using chi-squared and independent-samples t tests; multivariate logistic regression for predictor analysis.

Main Results:

• EBRT was the predominant first-line treatment for spinal mRCC (10,535 EBRT vs. 453 SBRT).
• Younger age, male sex, commercial insurance, and Midwest/Northeast residence predicted higher SBRT utilization.
• SBRT use declined after 2019, with EBRT consistently exceeding SBRT annually.

Conclusions:

• Conventional EBRT remains the standard of care for first-line treatment of spinal mRCC.
• Payer mechanisms and regional variations likely influence SBRT adoption, highlighting potential access barriers.
• Policy adjustments and infrastructure development are needed to improve equitable SBRT access aligned with evidence.