Radiation Treatment Patterns for Breast Cancer Brain Metastases

Radiation Treatment Patterns for Breast Cancer Brain Metastases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Radiation Treatment Patterns for Breast Cancer Brain Metastases Thamilini Pathmarajah, Yevgeniya Gokun, Nicole Williams, Gina M. Sizemore, and 18 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8545320/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Apr, 2026 Read the published version in Breast Cancer Research and Treatment → Version 1 posted 12 You are reading this latest preprint version Abstract Purpose: Breast cancer (BC) brain metastases (BM) treatment involves radiotherapy (RT), surgery, and CNS-penetrating systemic therapies. This study evaluated treatment patterns in brain RT and corresponding survival outcomes among patients with BC BM using the National Cancer Database (NCDB). Methods: Patients diagnosed with BC BM between 2010–2020 were identified. RT was categorized as whole brain (WBRT) vs. stereotactic (SRT). We fitted Overlap Propensity Score Weighting (OPSW) Cox models to account for confounders affecting OS. Variables included age, race, ethnicity, Charlson-Deyo score, insurance, molecular subtype, facility type, and systemic therapy. Results: Of 8,909 patients with BC BM, 43.4% received brain RT (74.1% WBRT, 25.9% SRS). Patients receiving RT tended to be younger, privately insured, triple-negative subtype, and received systemic therapy (all p < 0.001). There were no significant associations with race, ethnicity, education, or facility. However, patients that are African American, lower income, urban, triple-negative, or at community facilities were more likely to receive WBRT over SRS (p < 0.05). Median OS was 10.9 months (95% CI: 10.4–11.5). Systemic therapy alone (HR 0.40, 95% CI: 0.36–0.43) or combined with RT (HR 0.38, 95% CI: 0.35–0.42) improved OS, however RT alone did not improve survival on MVA (HR 0.96 (95% CI: 0.91–1.02). Among RT recipients, SRS was associated with improved OS vs. WBRT (HR 0.76, 95% CI: 0.69–0.83). Older age, comorbidities, lack of insurance, community facilities, and aggressive subtypes were associated with worse OS. Conclusions: Treatment patterns, particularly access to SRS, differ among BC BM patients. More prospective trials are needed to establish evidence-based treatment standards. breast cancer brain metastases stereotactic radiation whole brain radiation metastatic breast cancer Figures Figure 1 Figure 2 Introduction Patients with breast cancer brain metastases (BC BM) have traditionally been treated with local therapies, including surgery and radiation therapy (RT). The treatment of BC BM has evolved toward more frequent use of stereotactic radiosurgery (SRS) due to its excellent local control outcomes and reduced neurocognitive toxicity compared to whole brain radiation therapy (WBRT). However, the definition of “limited” brain metastases used to describe patients eligible for stereotactic brain radiation in the guidelines varies amongst providers. 1 Moreover, practice patterns and technical expertise in SRS among institutions vary. To further add to the complexity of the evolving multi-disciplinary treatment of BC BM, several targeted CNS-penetrating systemic therapies, such as tucatinib, trastuzumab-deruxtecan and sacituzumab, were recently approved for treatment of breast cancer brain metastases due to their efficacy in treating the CNS. Previous studies have established that numerous factors affect the onset and outcomes of BC BM among patient populations, including access to timely care, insurance coverage, and sociodemographic inequities 2 , 3 , 4 , 5 Kann et al. 6 has previously shown through retrospective analysis of NCDB data that non-White race, non-private insurance, lower socioeconomic status, and lower educational attainment were associated with lower use of SRS for brain metastases among patients with primary metastatic non-small cell lung cancer, breast cancer, colorectal cancer, or melanoma. 6 Additionally, a retrospective analysis of NCDB data by Mainwaring et al. highlighted that BC BM patients who received SRS differed from those who received WBRT on variables of income, insurance status, and treatment setting. 7 Given these differences in practice patterns, access to care, and stereotactic radiation capabilities among institutions, we hypothesized that disparities in RT treatment patterns may exist among patients with BC BM. We evaluated the NCDB database to further evaluate practice patterns in brain RT and corresponding survival outcomes among metastatic breast cancer patients with brain metastases. Methods Data Source and Study Cohort Patients diagnosed with breast cancer between 2010 and 2020 were identified in the National Cancer Database (NCDB). Patients with breast cancer and a diagnosis of brain metastases were included. As brain metastases were not recorded by the NCDB until 2010, patients prior to this were excluded. Patients without known follow-up or patients who received both stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) were excluded. Study Variables Covariates for this analysis included patient age, race, ethnicity, Charlson-Deyo score (CDS), health insurance status, census-derived median income and education for the patient’s zip code, urban/rural residence, treatment facility type, tumor grade, nodal status, molecular subtype, receipt of chemotherapy, immunotherapy, hormone therapy and sites of metastases at the diagnosis (bone, liver and lung). Molecular subtype was defined based on the NCDB variables for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2). Systemic therapy was composite indicator of receipt of chemotherapy, immunotherapy and/or hormone therapy. The Charlson-Deyo score predicts mortality based on a patient’s comorbidities. Main Exposure Brain radiation was defined based on Phase I through III Radiation Primary Treatment Volumes treated during first phase of radiation during first course of treatment. Treatment that was directed at the entire brain and its meninges (“WBRT”) or treatment that is directed at one or more sub-sites of the brain, but not the whole brain in 1, 3 or 5 fractions (“SRS”) were coded as receipt of brain radiation. End Point The primary outcome was all-cause mortality. The follow-up period was defined as the number of months from date of initial diagnosis of breast cancer to the event date, defined as 1) date of death, 2) date of the last follow-up, or 3) the end of the study, whichever came first. Patients who did not experience the event were censored at the date of the last follow-up or at the end of the follow-up, whichever occurred earlier. Statistical Analysis Descriptive statistics such as medians and interquartile ranges (IQRs) were used for continuous variables while frequencies and proportions were used for categorical variables. Differences between receipt and not receipt of brain RT groups were compared using Wilcoxon Rank Sum Test for continuous variables and Chi-square or Fisher’s exact test for categorical variables. We used Overlap Propensity Score Weighting (OPSW) to account for the impact of confounding by indication which results from the differences in baseline characteristics that affect receipt of appropriate group or treatment type. 8 Overlap weighting is a propensity score method that aims to imitate crucial features of randomized clinical trials, such as covariate balance and statistical precision. 9 OPSW has advantageous statistical properties such as exact balance of the means of every covariate included in the logistic regression models used to estimate propensity score. Propensity scores were estimated using a multivariable binary logistic regression model with group type (brain RT vs no brain RT) as the outcome and age, race, ethnicity, Charlson-Deyo score, insurance, community, subtype, treatment facility type and receipt of systemic therapy (composite measure) as covariates. The proportionality of hazards assumption was assessed using Schoenfeld residuals. It was violated when comparing patients who received brain radiation therapy vs those who did not receive and OS, hence OPSW Cox regression with robust variance was used to assess the relationship between time-varying interaction between receipt of brain RT and receipt of systemic therapy and overall survival adjusting. These analyses were repeated for subset of patients who received brain RT, specifically comparing those who received specific brain radiation type (SRS or WBRT). Propensity scores were estimated using a multivariable binary logistic regression model with group type (SRS vs no WBRT) as the outcome and age, race, ethnicity, Charlson-Deyo score, insurance, community, subtype, treatment facility type, chemotherapy, immunotherapy and hormone therapy as covariates. Proportionality was not violated hence OPSW Cox proportional hazard model with robust variance was used to assess the relationship between brain radiation type and OS. To assess the effectiveness of overlap propensity score weighting, we compared patients between these two therapy groups using standardized differences. Standardized difference is defined as absolute difference in means or proportions divided by pooled standard deviation. A standardized difference of less than 0.1 indicates insignificant imbalance between baseline characteristics and group type. 10 All analyses were performed using SAS version 9.4 (SAS Institute Inc). Two-sided tests were considered statistically significant at a significance level of 0.05. Results Patient Population: 8,909 patients with BC BM met the study inclusion criteria. Of the total cohort, 43.4% (n = 3,864) underwent brain radiation treatment (RT) for BC BM. 74.1% (n = 2,863) received whole brain radiation therapy (WBRT), while 25.9% (n = 1,001) received stereotactic radiosurgery (SRS). While the use of SRS increased compared to WBRT between 2010 and 2020, more patients still received WBRT at the end of the study period (Supplemental Fig. 1). The median age was 61 years (Interquartile range [IQR:] 52–69) and most patients (80.1%) had a Charlson-Deyo score of 0, indicating a low comorbidity burden. The majority of patients identified as White race (76.6%) and non-Hispanic (92.3%) ethnicity. The median follow-up was 9.8 months. Receipt of brain RT vs. no brain RT: Table 1 compares clinical and treatment characteristics among patients with BC BM receiving brain radiation (n = 3864) and those who did not (n = 5045). Patients who received RT were significantly younger (median age 60, IQR 52–68) than those who did not receive RT (median age 62, IQR 53–70, p < 0.001). Insurance status differed between the groups, with a higher proportion of patients who received brain radiation having private insurance (40.8% vs 35.3%, p < 0.001). There were no significant associations between receipt of brain RT and race (p = 0.608), ethnicity (p = 0.071), education (p = 0.249), community type (p = 0.071), or treatment facility type (p = 0.448). Table 1 Sociodemographic, Clinical and Treatment Characteristics Comparing Receipt of Brain Radiation to No Brain Radiation among Patients with Breast Cancer Brain Metastases (n = 8909) Total (n = 8,909) Brain Radiation (n = 3,864) No Brain Radiation (n = 5,045) P-value Age < .0001 Median (IQR) 61 (52, 69) 60 (52, 68) 62 (53, 70) Race , n (%) 0.6084 White 6767 (76.6%) 2946 (76.9%) 3821 (76.4%) African American/Black 1638 (18.6%) 714 (18.6%) 924 (18.5%) Asian 274 (3.1%) 111 (2.9%) 163 (3.3%) Other 151 (1.7%) 60 (1.6%) 91 (1.8%) Ethnicity , n (%) 0.0708 Non-Hispanic 8011 (92.3%) 3508 (92.9%) 4503 (91.9%) Hispanic 667 (7.7%) 268 (7.1%) 399 (8.1%) Charlson-Deyo Score , n (%) 0.3872 0 7133 (80.1%) 3118 (80.7%) 4015 (79.6%) 1 1184 (13.3%) 505 (13.1%) 679 (13.5%) 2 361 (4.1%) 152 (3.9%) 209 (4.1%) 3+ 231 (2.6%) 89 (2.3%) 142 (2.8%) Insurance , n (%) < .0001 Not Insured 642 (7.3%) 261 (6.9%) 381 (7.7%) Private Insurance 3294 (37.7%) 1553 (40.8%) 1741 (35.3%) Medicaid 1418 (16.2%) 634 (16.6%) 784 (15.9%) Medicare 3308 (37.9%) 1334 (35.0%) 1974 (40.1%) Other Government 73 (0.8%) 26 (0.7%) 47 (1.0%) Median Income Quartiles , n (%) 0.0273 < $ 46,227 1513 (17.0%) 666 (17.2%) 847 (16.8%) $ 46,227- $ 57,856 1806 (20.3%) 769 (19.9%) 1037 (20.6%) $ 57,587- $ 74,062 1797 (20.2%) 814 (21.1%) 983 (19.5%) $ 74,063 or higher 2582 (29.0%) 1063 (27.5%) 1519 (30.1%) Unknown 1211 (13.6%) 552 (14.3%) 659 (13.1%) Education , n (%) 0.2487 15.3% or higher 1919 (21.5%) 799 (20.7%) 1120 (22.2%) 9.1%-15.2% 2293 (25.7%) 1018 (26.3%) 1275 (25.3%) 5.0%-9.0% 2129 (23.9%) 911 (23.6%) 1218 (24.1%) < 5.0% 1380 (15.5%) 598 (15.5%) 782 (15.5%) Unknown 1188 (13.3%) 538 (13.9%) 650 (12.9%) Community , n (%) 0.0713 Rural 134 (1.5%) 62 (1.7%) 72 (1.5%) Urban 1083 (12.5%) 500 (13.4%) 583 (11.8%) Metro 7445 (86.0%) 3176 (85.0%) 4269 (86.7%) Treatment facility type , n (%) 0.4483 Community Cancer Program 594 (7.1%) 239 (6.6%) 355 (7.5%) Comprehensive Community Cancer Program 3164 (37.9%) 1377 (38.1%) 1787 (37.8%) Academic/Research Program 2873 (34.4%) 1259 (34.8%) 1614 (34.1%) Integrated Network Cancer Program 1714 (20.5%) 741 (20.5%) 973 (20.6%) Subtype , n (%) < .0001 ER+/PR+/HER2- 2647 (29.7%) 1012 (26.2%) 1635 (32.4%) ER+/PR (+ or -)/HER2+ 1190 (13.4%) 571 (14.8%) 619 (12.3%) ER-/PR-/HER2+ 938 (10.5%) 492 (12.7%) 446 (8.8%) ER-/PR-/HER2- 1705 (19.1%) 893 (23.1%) 812 (16.1%) Unknown 2429 (27.3%) 896 (23.2%) 1533 (30.4%) Chemotherapy , n (%) < .0001 Yes 4789 (54.8%) 2485 (65.4%) 2304 (46.6%) No 3955 (45.2%) 1317 (34.6%) 2638 (53.4%) Hormone therapy , n (%) 0.5764 Yes 3440 (39.3%) 1507 (39.7%) 1933 (39.1%) No 5303 (60.7%) 2291 (60.3%) 3012 (60.9%) Immunotherapy , n (%) < .0001 Yes 1626 (18.4%) 862 (22.4%) 764 (15.2%) No 7234 (81.6%) 2983 (77.6%) 4251 (84.8%) Systemic therapy , n (%) < .0001 Yes 6516 (73.3%) 3188 (82.6%) 3328 (66.1%) No 2379 (26.7%) 672 (17.4%) 1707 (33.9%) Bone-Mets at diagnosis , n (%) < .0001 Yes 5850 (66.3%) 2217 (57.9%) 3633 (72.7%) No 2978 (33.7%) 1613 (42.1%) 1365 (27.3%) Liver-Mets at diagnosis , n (%) 0.0002 Yes 2792 (32.0%) 1136 (29.9%) 1656 (33.7%) No 5924 (68.0%) 2662 (70.1%) 3262 (66.3%) Lung-Mets at diagnosis , n (%) 0.0236 Yes 3989 (46.0%) 1789 (47.3%) 2200 (44.9%) No 4690 (54.0%) 1990 (52.7%) 2700 (55.1%) Patients with triple negative metastatic breast cancer were more likely to receive brain RT than patients with ER + brain metastases (p < 0.001). Moreover, patients with the presence of extracranial bone metastases (p < .001) or liver metastases (p < .001) were less likely to undergo brain radiation. Receipt of systemic therapy (defined as any chemotherapy, immunotherapy or hormone therapy) was significantly associated with receipt of brain RT (82.6% vs 66.1%, p < 0.001). However, chemotherapy (p < 0.001) and immunotherapy (p < 0.001) showed stronger associations with receipt of RT than hormone therapy (p = .576). Receipt of SRS vs WBRT: Table 2 compares sociodemographic, clinical, and treatment characteristics among patients with breast cancer brain metastases receiving whole brain radiation therapy (WBRT) (n = 2863) vs. stereotactic radiation therapy (SRS) (n = 1001). African American patients (19.4% vs. 16.4%, p = 0.013), those with median income of < $ 46,227 (18.2% vs. 14.5%, p = 0.007), urban location (14.2% vs. 10.9%), p = 0.023), triple negative subtype (24.2% vs. 20.0%, p = 0.051), and comprehensive community cancer treatment facilities (39.2% vs. 34.9%, p < 0.001) were more likely to receive WBRT compared to SRS. In contrast, White patients (78.5% vs. 76.3%), those with median income of $ 74,063 or higher (30.7% vs. 26.4%, p = 0.007) and treatment at academic facilities (40.4% vs. 32.9%, p < 0.001) were more likely to undergo SRS compared to WBRT. Table 2 Sociodemographic, Clinical and Treatment Characteristics Comparing Receipt of Whole Brain Radiation Therapy (WBRT) to Stereotactic Radiosurgery (SRS) among Patients with Breast Cancer Brain Metastases (n = 3864) Total (n = 3,864) WBRT (n = 2,863) SRS (n = 1,001) P-value Age 0.0746 Median (IQR) 60 (52, 68) 60 (52, 68) 59 (51, 67) Race, n (%) 0.0132 White 2946 (76.9%) 2166 (76.3%) 780 (78.5%) African American/Black 714 (18.6%) 551 (19.4%) 163 (16.4%) Asian 111 (2.9%) 72 (2.5%) 39 (3.9%) Other 60 (1.6%) 49 (1.7%) 11 (1.1%) Ethnicity, n (%) 0.4754 Non-Hispanic 3508 (92.9%) 2596 (93.1%) 912 (92.4%) Hispanic 268 (7.1%) 193 (6.9%) 75 (7.6%) Charlson-Deyo Score, n (%) 0.0840 0 3118 (80.7%) 2293 (80.1%) 825 (82.4%) 1 505 (13.1%) 391 (13.7%) 114 (11.4%) 2 152 (3.9%) 107 (3.7%) 45 (4.5%) 3+ 89 (2.3%) 72 (2.5%) 17 (1.7%) Insurance, n (%) 0.0907 Not Insured 261 (6.9%) 207 (7.4%) 54 (5.4%) Private Insurance 1553 (40.8%) 1132 (40.2%) 421 (42.4%) Medicaid 634 (16.6%) 453 (16.1%) 181 (18.2%) Medicare 1334 (35.0%) 1003 (35.6%) 331 (33.3%) Other Government 26 (0.7%) 20 (0.7%) 6 (0.6%) Median Income Quartiles, n (%) 0.0066 < $ 46,227 666 (17.2%) 521 (18.2%) 145 (14.5%) $ 46,227- $ 57,856 769 (19.9%) 589 (20.6%) 180 (18.0%) $ 57,587- $ 74,062 814 (21.1%) 593 (20.7%) 221 (22.1%) $ 74,063 or higher 1063 (27.5%) 756 (26.4%) 307 (30.7%) Unknown 552 (14.3%) 404 (14.1%) 148 (14.8%) Education, n (%) 0.0159 15.3% or higher 799 (20.7%) 594 (20.7%) 205 (20.5%) 9.1%-15.2% 1018 (26.3%) 771 (26.9%) 247 (24.7%) 5.0%-9.0% 911 (23.6%) 692 (24.2%) 219 (21.9%) < 5.0% 598 (15.5%) 411 (14.4%) 187 (18.7%) Unknown 538 (13.9%) 395 (13.8%) 143 (14.3%) Community, n (%) 0.0230 Rural 62 (1.7%) 43 (1.6%) 19 (2.0%) Urban 500 (13.4%) 395 (14.2%) 105 (10.9%) Metro 3176 (85.0%) 2335 (84.2%) 841 (87.2%) Subtype, n (%) 0.0508 ER+/PR+/HER2- 1012 (26.2%) 724 (25.3%) 288 (28.8%) ER+/PR(+ or -)/HER2+ 571 (14.8%) 424 (14.8%) 147 (14.7%) ER-/PR-/HER2+ 492 (12.7%) 365 (12.7%) 127 (12.7%) ER-/PR-/HER2- 893 (23.1%) 693 (24.2%) 200 (20.0%) Unknown 896 (23.2%) 657 (22.9%) 239 (23.9%) Treatment Facility Type, n (%) < .0001 Community Cancer Program 239 (6.6%) 196 (7.3%) 43 (4.6%) Comprehensive Community Cancer Program 1377 (38.1%) 1054 (39.2%) 323 (34.9%) Academic/Research Program 1259 (34.8%) 885 (32.9%) 374 (40.4%) Integrated Network Cancer Program 741 (20.5%) 556 (20.7%) 185 (20.0%) Chemotherapy, n (%) < .0001 Yes 2485 (65.4%) 1787 (63.5%) 698 (70.7%) No 1317 (34.6%) 1028 (36.5%) 289 (29.3%) Hormone Therapy, n (%) 0.0081 Yes 1507 (39.7%) 1082 (38.4%) 425 (43.2%) No 2291 (60.3%) 1733 (61.6%) 558 (56.8%) Immunotherapy, n (%) 0.0001 Yes 862 (22.4%) 595 (20.9%) 267 (26.8%) No 2983 (77.6%) 2252 (79.1%) 731 (73.2%) Bone-Mets at diagnosis, n (%) 0.0671 Yes 2217 (57.9%) 1669 (58.7%) 548 (55.4%) No 1613 (42.1%) 1172 (41.3%) 441 (44.6%) Liver-Mets at diagnosis, n (%) 0.3428 Yes 1136 (29.9%) 854 (30.3%) 282 (28.7%) No 2662 (70.1%) 1962 (69.7%) 700 (71.3%) Lung-Mets at diagnosis, n (%) 0.0037 Yes 1789 (47.3%) 1366 (48.7%) 423 (43.3%) No 1990 (52.7%) 1437 (51.3%) 553 (56.7%) Receipt of Brain RT and associated survival outcomes: The median OS for the entire cohort of patients with breast cancer brain metastases was 10.9 months (95% CI: 10.4–11.5), including a 1-year OS rate of 48% (95% CI: 47%-49%) and a 2-year OS rate of 34% ((95% CI: 33%-35%). The Kaplan Meier curve in Supplemental Fig. 2 shows that patients who received brain RT had improved survival compared to those not receiving brain radiation (HR 0.89 (95% CI: 0.85–0.93)) within the first 4 years after treatment. After 4 years, brain radiation no longer conveyed significantly improved survival outcomes, most likely due to the limited number of cases with > 4 years survival (Supplemental Table 1). Regardless, the median OS for the RT cohort was 12.7 months (95% CI: 11.9–13.6), significantly longer median OS than the entire cohort. In the adjusted model, patients receiving systemic therapy only (HR: 0.40, 95% CI: 0.36–0.43)) or receipt of both brain RT and systemic therapy (HR: 0.38, 95% CI: 0.35–0.42) had significantly better survival outcomes than those receiving neither systemic therapy nor brain RT. Moreover, patients who received only brain RT were not significantly associated with improved OS. Patients on systemic therapy alone as well as patients with both brain RT and systemic therapy receipt continued to have better survival, even after 4 years post-diagnosis (Fig. 1 ). Multivariable analysis of all patients with BC BM showed that older patients (HR: 1.012, 95% CI: 1.009–1.016) with more co-morbidities (HR: 1.41, 95% CI: 1.15–1.74), no insurance (HR: 1.35, 95% CI: 1.19–1.53) or Medicaid (HR: 1.13, 95% CI: 1.04–1.24), treatment at community cancer centers (HR: 1.19, 95% CI: 1.05–1.35) and triple negative (HR: 1.84, 95% CI: 1.69-2.00) or ER-/PR-/Her-2+ (HR: 1.13, 95% CI: 1.02–1.25) molecular subtypes had increased mortality (Table 3 ). Table 3 Association between Receipt of Brain Radiation Therapy for Breast Cancer Brain Metastases and Overall Survival Crude HRs (95% CI) Adjusted HRs (95% CI)* Age 1-year increase 1.020 (1.018–1.022) 1.012 (1.009–1.016) 5-year increase 1.10 (1.09–1.11) 1.06 (1.05–1.08) Race White Ref Ref African American/Black 1.14 (1.08–1.21) 1.08 (1.00-1.17) Asian 0.79 (0.68–0.91) 0.82 (0.68–0.98) Other 0.68 (0.55–0.83) 0.94 (0.73–1.21) Ethnicity Non-Hispanic Ref Ref Hispanic 0.65 (0.59–0.72) 0.71 (0.63–0.80) Charlson-Deyo Score 0 Ref Ref 1 1.27 (1.19–1.36) 1.17 (1.07–1.27) 2 1.55 (1.38–1.74) 1.23 (1.07–1.42) 3+ 1.74 (1.51-2.00) 1.41 (1.15–1.74) Insurance Not Insured 1.35 (1.23–1.48) 1.35 (1.19–1.53) Private Insurance Ref Ref Medicaid 1.12 (1.05–1.21) 1.13 (1.04–1.24) Medicare 1.52 (1.44–1.60) 1.06 (0.98–1.15) Other Government 1.20 (0.91–1.54) 1.17 (0.72–1.88) Median Income Quartiles < $ 46,227 1.19 (1.11–1.28) ---- $ 46,227- $ 57,856 1.20 (1.12–1.28) ---- $ 57,587- $ 74,062 1.19 (1.11–1.27) ---- $ 74,063 or higher Ref ---- Unknown 1.10 (1.02–1.19) ---- Education 15.3% or higher 1.07 (0.99–1.16) ---- 9.1%-15.2% 1.21 (1.12–1.31) ---- 5.0%-9.0% 1.09 (1.01–1.18) ---- < 5.0% Ref ---- Unknown 1.07 (0.98–1.17) ---- Community Rural 1.20 (0.99–1.43) 1.09 (0.88–1.36) Urban 1.13 (1.06–1.21) 1.08 (1.00-1.18) Metro Ref Ref Subtype ER+/PR+/HER2- Ref Ref ER+/PR (+ or -)/HER2+ 0.84 (0.77–0.90) 0.90 (0.82–0.98) ER-/PR-/HER2+ 1.08 (0.99–1.18) 1.13 (1.02–1.25) ER-/PR-/HER2- 1.96 (1.83–2.09) 1.84 (1.69-2.00) Unknown 1.54 (1.45–1.64) 1.32 (1.22–1.42) Treatment facility type Community Cancer Program 1.26 (1.14–1.39) 1.19 (1.05–1.35) Comprehensive Community Cancer Program 1.25 (1.18–1.32) 1.21 (1.13–1.30) Academic/Research Program Ref Ref Integrated Network Cancer Program 1.25 (1.17–1.34) 1.26 (1.17–1.36) Among the cohort of patients that underwent brain radiation (SRS or WBRT), patients undergoing SRS had better survival outcomes compared to patients undergoing WBRT (HR: 0.76, 95% CI: 0.69–0.83) after adjusting for age, race, ethnicity, CDS, insurance, community, subtype, treatment facility type, chemotherapy, hormone therapy and immunotherapy (Fig. 2 ). In addition to patients receiving WBRT, older patients (HR: 1.012, 95% CI: 1.006–1.018) with more co-morbidities (HR: 1.61, 95% CI: 1.24–2.10), lack of insurance (HR: 1.25, 95% CI: 1.02–1.53), triple negative molecular subtype (HR: 1.45, 95% CI: 1.20–1.75) with treatment at comprehensive community cancer centers (HR: 1.24, 95% CI: 1.11–1.38) had worse survival outcomes in this adjusted model (Table 4 ). Table 4 Association between Receipt of Brain Radiation Therapy Type for Breast Cancer Brain Metastases and Overall Survival Crude HRs (95% CI) Adjusted HRs (95% CI)* Age 1-year increase 1.021 (1.018–1.024) 1.012 (1.006–1.018) 5-year increase 1.11 (1.09–1.13) 1.06 (1.03–1.10) Race White Ref Ref African American/Black 1.17 (1.07–1.29) 1.14 (0.98–1.31) Asian 0.74 (0.60–0.92) 0.69 (0.51–0.95) Other 0.70 (0.51–0.95) 0.98 (0.56–1.71) Ethnicity Non-Hispanic Ref Ref Hispanic 0.62 (0.53–0.73) 0.74 (0.60–0.92) Charlson-Deyo Score 0 Ref Ref 1 1.33 (1.20–1.48) 1.18 (1.01–1.37) 2 1.57 (1.30–1.89) 1.33 (1.07–1.65) 3+ 1.85 (1.46–2.35) 1.61 (1.24–2.10) Insurance Not Insured 1.32 (1.15–1.52) 1.25 (1.02–1.53) Private Insurance Ref Ref Medicaid 1.04 (0.94–1.16) 1.13 (0.99–1.30) Medicare 1.55 (1.43–1.69) 1.16 (1.01–1.33) Other Government 1.34 (0.83–2.15) 1.11 (0.53–2.34) Median Income Quartiles < $ 46,227 1.24 (1.12–1.39) ---- $ 46,227- $ 57,856 1.32 (1.18–1.46) ---- $ 57,587- $ 74,062 1.25 (1.13–1.38) ---- $ 74,063 or higher Ref ---- Unknown 1.18 (1.06–1.32) ---- Education 15.3% or higher 1.20 (1.07–1.36) ---- 9.1%-15.2% 1.23 (1.10–1.38) ---- 5.0%-9.0% 1.15 (1.03–1.29) ---- < 5.0% Ref ---- Unknown 1.16 (1.02–1.32) ---- Community Rural 1.18 (0.90–1.55) 1.20 (0.88–1.64) Urban 1.21 (1.09–1.34) 1.06 (0.91–1.23) Metro Ref Ref Subtype ER+/PR+/HER2- Ref Ref ER+/PR (+ or -)/HER2+ 0.73 (0.66–0.82) 0.96 (0.79–1.17) ER-/PR-/HER2+ 0.99 (0.88–1.11) 1.08 (0.89–1.32) ER-/PR-/HER2- 1.81 (1.64–2.01) 1.45 (1.20–1.75) Unknown 1.37 (1.24–1.51) 1.27 (1.11–1.46) Treatment facility type , n (%) Community Cancer Program 1.36 (1.16–1.60) 1.20 (0.94–1.53) Comprehensive Community Cancer Program 1.33 (1.22–1.45) 1.24 (1.11–1.38) Academic/Research Program Ref Ref Integrated Network Cancer Program 1.26 (1.14–1.39) 1.22 (1.07–1.39) Chemotherapy Yes 0.54 (0.50–0.59) 0.58 (0.52–0.65) No Ref Ref Hormone therapy Yes 0.67 (0.63–0.72) 0.61 (0.54–0.70) No Ref Ref Immunotherapy Yes 0.51 (0.47–0.56) 0.64 (0.56–0.73) No Ref Ref Type of Brain Radiation Whole Bran Radiation Therapy (WBRT) Ref Ref Stereotactic Radiosurgery (SRS) 0.79 (0.72–0.86) 0.76 (0.69–0.83) Discussion The diagnosis of breast cancer brain metastases remains a devastating event for patients, yet multi-disciplinary treatment approaches including SRS and CNS-penetrating systemic therapies continues to improve survival outcomes while minimizing toxicity. However, there is no standard treatment for breast cancer brain metastases, particularly for brain radiation and its integration of systemic therapy. Younger patients with triple negative breast cancers were more likely to receive radiation. Similarly, patients who underwent systemic therapy, specifically chemotherapy and immunotherapy, were more likely to undergo brain radiation. These trends reflect more comprehensive treatment in patients with good performance status and aggressive breast cancers. Older patients, particularly those with ER + BM and those with Medicare, were less likely to receive brain radiation. This may be explained by patient preference for less aggressive treatment or hospice based on their age or declining functional status at the time of brain metastases diagnosis. However, it is important to note that our previously published study showed that older patients > 65 yo tolerated stereotactic radiation with excellent outcomes and that age alone should not dictate treatment decisions 11 . Interestingly, there were no statistically significant associations between receipt of brain radiation (either WBRT or SRS) and race, ethnicity, education, community type, or type of treatment facility. This suggests that access to routine whole brain radiation appears to be more equitable across sociodemographic groups than SRS. African American patients, those with lower median income, urban location, triple negative molecular subtype and community treatment facilities were more likely to receive WBRT compared to SRS. In contrast, White patients, those with higher median income treated at academic facilities were more likely to undergo SRS compared to WBRT. Despite the shifting paradigm toward increased utilization of SRS over the past 20 years (Supplemental Fig. 2), the specialized technical expertise and equipment necessary for stereotactic brain treatments are not readily accessible to all patients. Indeed, only a minority of patients (~ 35%) diagnosed with BC BM in 2020 that received radiation underwent SRS (Supplemental Fig. 2). These findings align with those reported by Kann et al., whose retrospective analysis of NCDB data revealed that non-White race and non-private insurance was associated with lower use of SRS for brain metastases from a variety of primary cancers. 6 These results are also consistent with Mainwaring et al 7 that highlight barriers to accessing SRS. We similarly show that WBRT remains more prevalent than SRS over the period of our study. While systemic therapy is considered the primary driver of survival outcomes in metastatic breast cancer, the survival benefit from brain radiation remains uncertain. The Quartz Trial, one of the only randomized clinical trials comparing brain radiation (WBRT) versus supportive care in metastatic NSCLC patients, found no survival benefit to whole brain radiation. However, it is important to note that patients included in the Quartz trial had poor prognosis and performance status 12 . Moreover, the multi-institutional retrospective analysis by Pike et al. (2024) showed patients with metastatic NSCLC to the brain that underwent treatment with tyrosine kinase inhibitors +/- SRS showed no apparent survival advantage with the up-front use of radiosurgery, however did show increased local control with SRS in metastases > 1 cm. 13 Similarly, our study suggests no independent survival benefit from brain radiation when adjusting for systemic therapy on MVA. Our multivariable analysis showed that younger patients with fewer co-morbidities, private insurance, and treatment at academic institutions had improved survival. Improved survival outcomes for breast cancer patients with brain metastases treated at academic institutions may be attributed to the comprehensive multi-disciplinary approach facilitated by tumor boards and specialized clinics. These settings enable integrated decision-making involving Radiation Oncology, Medical Oncology, Neurosurgery, Neuro Oncology, Neuroradiology leading to tailored treatment plans that optimize the use of CNS penetrating systemic therapies and their integration with radiation. Our study showed that patients with more aggressive triple negative and Her-2 + molecular subtypes had worse outcomes. However, it is important to note that many of these patients were diagnosed before the FDA approval of CNS-penetrating systemic therapies in 2020, including tucatinib, fam-trastuzumab deruxtecan and Sacituzumab govitecan, which have shown improved survival outcomes in Her-2 + and triple negative breast cancer patients, respectively. 14 , 15 , 16 , 17 . While OS of patients with BC BM has significantly improved between 2010–2020 (Supplemental Fig. 3), survival outcomes for HER2-positive and triple negative patients are likely to continue to improve as the NCDB incorporates more recent data following the recent FDA approvals of CNS-penetrating systemic therapies. Moreover, patients who underwent systemic therapy (chemotherapy, immunotherapy or hormone therapy) in addition to brain radiation had better survival, further reinforcing that systemic therapy drives prognosis. Interestingly, patients receiving SRS had a lower risk of death (24%) compared to those receiving whole brain radiation. This finding is inconsistent with previous randomized clinical trials demonstrating that SRS and WBRT result in similar OS outcomes. While SRS results in excellent local control outcomes and improved quality of life, WBRT results in improved intracranial progression free survival (PFS) without an OS benefit. 18 We acknowledge that this discrepancy is most likely due to selection bias in our retrospective study as patients receiving whole brain radiation typically have higher burden of CNS disease and worse prognosis, while SRS is often reserved for patients with “limited” brain metastases and better performance status. A major limitation of NCDB studies is that NCDB does not capture details on extent of brain metastases (number and volume), brain metastases velocity, intracranial progression free survival or presence of leptomeningeal disease, which limited our ability to fully elucidate treatment rationales and better understand survival outcomes. Unfortunately, data on quality of life and neurocognitive function are also not available in the NCDB database. In conclusion, our study highlights disparities in breast cancer brain metastases treatment, particularly in treatment patterns and access to stereotactic radiation. SRS offers quality of life benefits that are critical as newer CNS penetrating systemic therapies prolong survival for these patients. While a major limitation of this study is that NCDB does not capture data on symptoms, extent of disease and QOL outcomes, it does demonstrate that efforts to improve access to SRS are essential. Prospective trials evaluating SRS in the context of modern CNS-penetrating systemic therapies and corresponding QOL outcomes are needed to establish evidence-based standards for BCBM across all sociodemographic groups. Declarations Author Contribution T.P. and S. B. wrote the manuscriptY.G and B.S. performed the statistics and prepared the figures and tablesAll other authors analyzed the data and reviewed the manuscript. Data Availability Data are available in the National Cancer Database (NCDB) upon request at https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/. References Vogelbaum MA, Brown PD, Messersmith H, et al. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline. JCO . 2022;40(5):492-516. doi:10.1200/JCO.21.02314 Gomez D, Feng JJ, Cheok S, et al. Incidence of brain metastasis according to patient race and primary cancer origin: a systematic review. J Neurooncol . 2024;169(3):457-467. doi:10.1007/s11060-024-04748-6 Schootman M, Jeffe DB, Gillanders WE, Aft R. Racial disparities in the development of breast cancer metastases among older women: a multilevel study. Cancer . 2009;115(4):731-740. doi:10.1002/cncr.24087 Wu J, Ye J, Wu W, et al. Racial disparities in young-onset patients with colorectal, breast and testicular cancer. J Cancer . 2019;10(22):5388-5396. doi:10.7150/jca.32435 Ren JX, Gong Y, Ling H, Hu X, Shao ZM. Racial/ethnic differences in the outcomes of patients with metastatic breast cancer: contributions of demographic, socioeconomic, tumor and metastatic characteristics. Breast Cancer Res Treat . 2019;173(1):225-237. doi:10.1007/s10549-018-4956-y Kann BH, Park HS, Johnson SB, Chiang VL, Yu JB. Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States. J Natl Compr Canc Netw . 2017;15(12):1494-1502. doi:10.6004/jnccn.2017.7003 Mainwaring W, Bowers J, Pham N, et al. Stereotactic Radiosurgery Versus Whole Brain Radiation Therapy: A Propensity Score Analysis and Predictors of Care for Patients With Brain Metastases From Breast Cancer. Clin Breast Cancer . 2019;19(2):e343-e351. doi:10.1016/j.clbc.2018.11.001 Li F. Balancing Covariates via Propensity Score Weighting: Journal of the American Statistical Association: Vol 113, No 521. Accessed July 3, 2025. https://www.tandfonline.com/doi/abs/10.1080/01621459.2016.1260466 Thomas LE, Li F, Pencina MJ. Overlap Weighting: A Propensity Score Method That Mimics Attributes of a Randomized Clinical Trial. JAMA . 2020;323(23):2417. doi:10.1001/jama.2020.7819 Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behav Res . 2011;46(3):399-424. doi:10.1080/00273171.2011.568786 Upadhyay R, Klamer BG, Perlow HK, et al. Stereotactic Radiosurgery for Women Older than 65 with Breast Cancer Brain Metastases. Cancers (Basel) . 2023;16(1):137. doi:10.3390/cancers16010137 Mulvenna P, Nankivell M, Barton R, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. The Lancet . 2016;388(10055):2004-2014. doi:10.1016/S0140-6736(16)30825-X Pike LRG, Miao E, Boe LA, et al. Tyrosine Kinase Inhibitors With and Without Up-Front Stereotactic Radiosurgery for Brain Metastases From EGFR and ALK Oncogene-Driven Non-Small Cell Lung Cancer (TURBO-NSCLC). J Clin Oncol . 2024;42(30):3606-3617. doi:10.1200/JCO.23.02668 Saura C, Modi S, Krop I, et al. Trastuzumab deruxtecan in previously treated patients with HER2-positive metastatic breast cancer: updated survival results from a phase II trial (DESTINY-Breast01). Ann Oncol . 2024;35(3):302-307. doi:10.1016/j.annonc.2023.12.001 André F, Park YH, Kim SB, et al. Trastuzumab deruxtecan versus treatment of physician’s choice in patients with HER2-positive metastatic breast cancer (DESTINY-Breast02): a randomised, open-label, multicentre, phase 3 trial. The Lancet . 2023;401(10390):1773-1785. doi:10.1016/S0140-6736(23)00725-0 Cortés J, Kim SB, Chung WP, et al. Trastuzumab Deruxtecan versus Trastuzumab Emtansine for Breast Cancer. New England Journal of Medicine . 2022;386(12):1143-1154. doi:10.1056/NEJMoa2115022 Murthy RK, Loi S, Okines A, et al. Tucatinib, Trastuzumab, and Capecitabine for HER2-Positive Metastatic Breast Cancer. New England Journal of Medicine . 2020;382(7):597-609. doi:10.1056/NEJMoa1914609 Brown PD, Ballman KV, Cerhan JH, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. The Lancet Oncology . 2017;18(8):1049-1060. doi:10.1016/S1470-2045(17)30441-2 Additional Declarations No competing interests reported. Supplementary Files SupplementalData11425.docx SupplementalFigure1.jpg SupplementalFigure2.jpg SupplementalFigure3.jpg Cite Share Download PDF Status: Published Journal Publication published 22 Apr, 2026 Read the published version in Breast Cancer Research and Treatment → Version 1 posted Editorial decision: Revision requested 17 Feb, 2026 Reviews received at journal 17 Feb, 2026 Reviews received at journal 15 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 03 Feb, 2026 Editor assigned by journal 08 Jan, 2026 Submission checks completed at journal 08 Jan, 2026 First submitted to journal 07 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Jhawar","email":"","orcid":"","institution":"The Ohio State University Comprehensive Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Sachin","middleName":"R.","lastName":"Jhawar","suffix":""},{"id":586637343,"identity":"fb59a71e-3c3e-46c5-afd8-b7c2b8ee7ae5","order_by":21,"name":"Sasha Beyer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYHACNiA+AGIwPoAJSRCrhdmAZC1scJV4tci3H3/24AfDHTmD473PKj78ORzN38B88DYPHi0GZ3LMDXsYnhkbnDludnNm2+HcGQfYkq3xamHIYZPgYTicuOFGGttt3obDuRsYeMyk8WmR73/+TPIPw+H6DfefsRXz/AFp4f+GVwvDjQSQmYcTDG6wsTHzsIFtYcOrxeDGGzNpGYNnhjPPpDFLzmxLz51xmM3Ycg5eh6U/k3xTcUee7/gxxg8f/ljn9rc3P7zxBp/DIHYxMCgcgHGYCSqHWddArMpRMApGwSgYcQAApiZOgQO2KHoAAAAASUVORK5CYII=","orcid":"","institution":"The Ohio State University Comprehensive Cancer Center","correspondingAuthor":true,"prefix":"","firstName":"Sasha","middleName":"","lastName":"Beyer","suffix":""}],"badges":[],"createdAt":"2026-01-07 21:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8545320/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8545320/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10549-026-07955-z","type":"published","date":"2026-04-22T15:59:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":102182069,"identity":"7d409d41-de21-467e-9354-0e8d66460714","added_by":"auto","created_at":"2026-02-09 07:27:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":427132,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Kaplan Meier Curve Comparing OS among Patients Treated with Systemic Therapy Only, Brain RT Only, Both, or Neither for Breast Cancer Brain Metastases (B) Time-varying association between Brain Radiation Receipt and Systemic Therapy with Overall Survival.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8545320/v1/23c875875567fd94aac6e3b1.jpg"},{"id":102182062,"identity":"605f47e6-3143-4c9c-9584-444d150fcaa1","added_by":"auto","created_at":"2026-02-09 07:27:38","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44816,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan Meier Curve Modeling OS between Patients Receiving WBRT or SRS for Breast Cancer Brain Metastases\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8545320/v1/17617c86af536a65e79bdb1e.jpg"},{"id":107929229,"identity":"3cf18b2f-71a0-4c89-a3d3-cbd9cc09ad81","added_by":"auto","created_at":"2026-04-27 16:14:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1301037,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8545320/v1/ab2ef5b2-4468-49ba-9225-b5f7df063ab9.pdf"},{"id":102182096,"identity":"d3ea2ebb-f71f-4a15-961d-500b5c1b575c","added_by":"auto","created_at":"2026-02-09 07:27:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":50842,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalData11425.docx","url":"https://assets-eu.researchsquare.com/files/rs-8545320/v1/70b17177f68d3db76a8f0a2c.docx"},{"id":102182088,"identity":"c913164c-1ce8-4fed-b463-c8a45206a603","added_by":"auto","created_at":"2026-02-09 07:27:38","extension":"jpg","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":191358,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFigure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8545320/v1/d5fce766ed93a5279ea9b9a2.jpg"},{"id":102182093,"identity":"8e13d8cc-8cb0-44b9-88c2-109d0001f852","added_by":"auto","created_at":"2026-02-09 07:27:41","extension":"jpg","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":24321,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFigure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8545320/v1/631d583ba494fe5093ecea51.jpg"},{"id":102182061,"identity":"11acacfc-142a-4a66-9f56-dbfae7dba4b1","added_by":"auto","created_at":"2026-02-09 07:27:38","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":67295,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFigure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8545320/v1/46e6231c5941601ce7cf54ed.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Radiation Treatment Patterns for Breast Cancer Brain Metastases","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePatients with breast cancer brain metastases (BC BM) have traditionally been treated with local therapies, including surgery and radiation therapy (RT). The treatment of BC BM has evolved toward more frequent use of stereotactic radiosurgery (SRS) due to its excellent local control outcomes and reduced neurocognitive toxicity compared to whole brain radiation therapy (WBRT). However, the definition of \u0026ldquo;limited\u0026rdquo; brain metastases used to describe patients eligible for stereotactic brain radiation in the guidelines varies amongst providers.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Moreover, practice patterns and technical expertise in SRS among institutions vary. To further add to the complexity of the evolving multi-disciplinary treatment of BC BM, several targeted CNS-penetrating systemic therapies, such as tucatinib, trastuzumab-deruxtecan and sacituzumab, were recently approved for treatment of breast cancer brain metastases due to their efficacy in treating the CNS.\u003c/p\u003e \u003cp\u003ePrevious studies have established that numerous factors affect the onset and outcomes of BC BM among patient populations, including access to timely care, insurance coverage, and sociodemographic inequities\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Kann et al.\u003csup\u003e6\u003c/sup\u003e has previously shown through retrospective analysis of NCDB data that non-White race, non-private insurance, lower socioeconomic status, and lower educational attainment were associated with lower use of SRS for brain metastases among patients with primary metastatic non-small cell lung cancer, breast cancer, colorectal cancer, or melanoma.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Additionally, a retrospective analysis of NCDB data by Mainwaring et al. highlighted that BC BM patients who received SRS differed from those who received WBRT on variables of income, insurance status, and treatment setting.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e Given these differences in practice patterns, access to care, and stereotactic radiation capabilities among institutions, we hypothesized that disparities in RT treatment patterns may exist among patients with BC BM. We evaluated the NCDB database to further evaluate practice patterns in brain RT and corresponding survival outcomes among metastatic breast cancer patients with brain metastases.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Source and Study Cohort\u003c/h2\u003e \u003cp\u003ePatients diagnosed with breast cancer between 2010 and 2020 were identified in the National Cancer Database (NCDB). Patients with breast cancer and a diagnosis of brain metastases were included. As brain metastases were not recorded by the NCDB until 2010, patients prior to this were excluded. Patients without known follow-up or patients who received both stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) were excluded.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Variables\u003c/h3\u003e\n\u003cp\u003eCovariates for this analysis included patient age, race, ethnicity, Charlson-Deyo score (CDS), health insurance status, census-derived median income and education for the patient\u0026rsquo;s zip code, urban/rural residence, treatment facility type, tumor grade, nodal status, molecular subtype, receipt of chemotherapy, immunotherapy, hormone therapy and sites of metastases at the diagnosis (bone, liver and lung). Molecular subtype was defined based on the NCDB variables for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2). Systemic therapy was composite indicator of receipt of chemotherapy, immunotherapy and/or hormone therapy. The Charlson-Deyo score predicts mortality based on a patient\u0026rsquo;s comorbidities.\u003c/p\u003e\n\u003ch3\u003eMain Exposure\u003c/h3\u003e\n\u003cp\u003eBrain radiation was defined based on Phase I through III Radiation Primary Treatment Volumes treated during first phase of radiation during first course of treatment. Treatment that was directed at the entire brain and its meninges (\u0026ldquo;WBRT\u0026rdquo;) or treatment that is directed at one or more sub-sites of the brain, but not the whole brain in 1, 3 or 5 fractions (\u0026ldquo;SRS\u0026rdquo;) were coded as receipt of brain radiation.\u003c/p\u003e\n\u003ch3\u003eEnd Point\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was all-cause mortality. The follow-up period was defined as the number of months from date of initial diagnosis of breast cancer to the event date, defined as 1) date of death, 2) date of the last follow-up, or 3) the end of the study, whichever came first. Patients who did not experience the event were censored at the date of the last follow-up or at the end of the follow-up, whichever occurred earlier.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics such as medians and interquartile ranges (IQRs) were used for continuous variables while frequencies and proportions were used for categorical variables. Differences between receipt and not receipt of brain RT groups were compared using Wilcoxon Rank Sum Test for continuous variables and Chi-square or Fisher\u0026rsquo;s exact test for categorical variables.\u003c/p\u003e \u003cp\u003eWe used Overlap Propensity Score Weighting (OPSW) to account for the impact of confounding by indication which results from the differences in baseline characteristics that affect receipt of appropriate group or treatment type.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Overlap weighting is a propensity score method that aims to imitate crucial features of randomized clinical trials, such as covariate balance and statistical precision.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e OPSW has advantageous statistical properties such as exact balance of the means of every covariate included in the logistic regression models used to estimate propensity score.\u003c/p\u003e \u003cp\u003ePropensity scores were estimated using a multivariable binary logistic regression model with group type (brain RT vs no brain RT) as the outcome and age, race, ethnicity, Charlson-Deyo score, insurance, community, subtype, treatment facility type and receipt of systemic therapy (composite measure) as covariates.\u003c/p\u003e \u003cp\u003eThe proportionality of hazards assumption was assessed using Schoenfeld residuals. It was violated when comparing patients who received brain radiation therapy vs those who did not receive and OS, hence OPSW Cox regression with robust variance was used to assess the relationship between time-varying interaction between receipt of brain RT and receipt of systemic therapy and overall survival adjusting.\u003c/p\u003e \u003cp\u003eThese analyses were repeated for subset of patients who received brain RT, specifically comparing those who received specific brain radiation type (SRS or WBRT). Propensity scores were estimated using a multivariable binary logistic regression model with group type (SRS vs no WBRT) as the outcome and age, race, ethnicity, Charlson-Deyo score, insurance, community, subtype, treatment facility type, chemotherapy, immunotherapy and hormone therapy as covariates. Proportionality was not violated hence OPSW Cox proportional hazard model with robust variance was used to assess the relationship between brain radiation type and OS.\u003c/p\u003e \u003cp\u003eTo assess the effectiveness of overlap propensity score weighting, we compared patients between these two therapy groups using standardized differences. Standardized difference is defined as absolute difference in means or proportions divided by pooled standard deviation. A standardized difference of less than 0.1 indicates insignificant imbalance between baseline characteristics and group type.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAll analyses were performed using SAS version 9.4 (SAS Institute Inc). Two-sided tests were considered statistically significant at a significance level of 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePatient Population:\u003c/h2\u003e \u003cp\u003e8,909 patients with BC BM met the study inclusion criteria. Of the total cohort, 43.4% (n\u0026thinsp;=\u0026thinsp;3,864) underwent brain radiation treatment (RT) for BC BM. 74.1% (n\u0026thinsp;=\u0026thinsp;2,863) received whole brain radiation therapy (WBRT), while 25.9% (n\u0026thinsp;=\u0026thinsp;1,001) received stereotactic radiosurgery (SRS). While the use of SRS increased compared to WBRT between 2010 and 2020, more patients still received WBRT at the end of the study period (Supplemental Fig.\u0026nbsp;1). The median age was 61 years (Interquartile range [IQR:] 52\u0026ndash;69) and most patients (80.1%) had a Charlson-Deyo score of 0, indicating a low comorbidity burden. The majority of patients identified as White race (76.6%) and non-Hispanic (92.3%) ethnicity. The median follow-up was 9.8 months.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eReceipt of brain RT vs. no brain RT:\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e compares clinical and treatment characteristics among patients with BC BM receiving brain radiation (n\u0026thinsp;=\u0026thinsp;3864) and those who did not (n\u0026thinsp;=\u0026thinsp;5045). Patients who received RT were significantly younger (median age 60, IQR 52\u0026ndash;68) than those who did not receive RT (median age 62, IQR 53\u0026ndash;70, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Insurance status differed between the groups, with a higher proportion of patients who received brain radiation having private insurance (40.8% vs 35.3%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no significant associations between receipt of brain RT and race (p\u0026thinsp;=\u0026thinsp;0.608), ethnicity (p\u0026thinsp;=\u0026thinsp;0.071), education (p\u0026thinsp;=\u0026thinsp;0.249), community type (p\u0026thinsp;=\u0026thinsp;0.071), or treatment facility type (p\u0026thinsp;=\u0026thinsp;0.448).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic, Clinical and Treatment Characteristics Comparing Receipt of Brain Radiation to No Brain Radiation among Patients with Breast Cancer Brain Metastases (n\u0026thinsp;=\u0026thinsp;8909)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;8,909)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrain Radiation (n\u0026thinsp;=\u0026thinsp;3,864)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo Brain Radiation\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5,045)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (52, 69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (52, 68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (53, 70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6767 (76.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2946 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3821 (76.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican American/Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1638 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e714 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e924 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e274 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0708\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8011 (92.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3508 (92.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4503 (91.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e667 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e399 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharlson-Deyo Score\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7133 (80.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3118 (80.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4015 (79.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1184 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e505 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e679 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e361 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e209 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e231 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsurance\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Insured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e642 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e261 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e381 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3294 (37.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1553 (40.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1741 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1418 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e634 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e784 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3308 (37.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1334 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1974 (40.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Government\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedian Income Quartiles\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u003cspan\u003e$\u003c/span\u003e46,227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1513 (17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e666 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e847 (16.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e46,227-\u003cspan\u003e$\u003c/span\u003e57,856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1806 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e769 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1037 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e57,587-\u003cspan\u003e$\u003c/span\u003e74,062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1797 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e814 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e983 (19.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e74,063 or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2582 (29.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1063 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1519 (30.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1211 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e552 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e659 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15.3% or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1919 (21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e799 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1120 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.1%-15.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2293 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1018 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1275 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0%-9.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2129 (23.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e911 (23.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1218 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1380 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e598 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e782 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1188 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e538 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e650 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0713\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1083 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e500 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e583 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7445 (86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3176 (85.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4269 (86.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment facility type\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4483\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e594 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e355 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComprehensive Community Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3164 (37.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1377 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1787 (37.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic/Research Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2873 (34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1259 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1614 (34.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegrated Network Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1714 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e741 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e973 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubtype\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER+/PR+/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2647 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1012 (26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1635 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER+/PR (+\u0026thinsp;or -)/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1190 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e571 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e619 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER-/PR-/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e938 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e492 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e446 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER-/PR-/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1705 (19.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e893 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e812 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2429 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e896 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1533 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4789 (54.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2485 (65.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2304 (46.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3955 (45.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1317 (34.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2638 (53.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHormone therapy\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3440 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1507 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1933 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5303 (60.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2291 (60.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3012 (60.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmunotherapy\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1626 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e862 (22.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e764 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7234 (81.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2983 (77.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4251 (84.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystemic therapy\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6516 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3188 (82.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3328 (66.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2379 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e672 (17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1707 (33.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBone-Mets at diagnosis\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5850 (66.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2217 (57.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3633 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2978 (33.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1613 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1365 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiver-Mets at diagnosis\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2792 (32.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1136 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1656 (33.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5924 (68.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2662 (70.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3262 (66.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLung-Mets at diagnosis\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3989 (46.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1789 (47.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2200 (44.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4690 (54.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1990 (52.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2700 (55.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatients with triple negative metastatic breast cancer were more likely to receive brain RT than patients with ER\u0026thinsp;+\u0026thinsp;brain metastases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, patients with the presence of extracranial bone metastases (p\u0026thinsp;\u0026lt;\u0026thinsp;.001) or liver metastases (p\u0026thinsp;\u0026lt;\u0026thinsp;.001) were less likely to undergo brain radiation. Receipt of systemic therapy (defined as any chemotherapy, immunotherapy or hormone therapy) was significantly associated with receipt of brain RT (82.6% vs 66.1%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, chemotherapy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and immunotherapy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) showed stronger associations with receipt of RT than hormone therapy (p\u0026thinsp;=\u0026thinsp;.576).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eReceipt of SRS vs WBRT:\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e compares sociodemographic, clinical, and treatment characteristics among patients with breast cancer brain metastases receiving whole brain radiation therapy (WBRT) (n\u0026thinsp;=\u0026thinsp;2863) vs. stereotactic radiation therapy (SRS) (n\u0026thinsp;=\u0026thinsp;1001). African American patients (19.4% vs. 16.4%, p\u0026thinsp;=\u0026thinsp;0.013), those with median income of \u0026lt;\u003cspan\u003e$\u003c/span\u003e46,227 (18.2% vs. 14.5%, p\u0026thinsp;=\u0026thinsp;0.007), urban location (14.2% vs. 10.9%), p\u0026thinsp;=\u0026thinsp;0.023), triple negative subtype (24.2% vs. 20.0%, p\u0026thinsp;=\u0026thinsp;0.051), and comprehensive community cancer treatment facilities (39.2% vs. 34.9%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were more likely to receive WBRT compared to SRS. In contrast, White patients (78.5% vs. 76.3%), those with median income of \u003cspan\u003e$\u003c/span\u003e74,063 or higher (30.7% vs. 26.4%, p\u0026thinsp;=\u0026thinsp;0.007) and treatment at academic facilities (40.4% vs. 32.9%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were more likely to undergo SRS compared to WBRT.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic, Clinical and Treatment Characteristics Comparing Receipt of Whole Brain Radiation Therapy (WBRT) to Stereotactic Radiosurgery (SRS) among Patients with Breast Cancer Brain Metastases (n\u0026thinsp;=\u0026thinsp;3864)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;3,864)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWBRT\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;2,863)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSRS\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1,001)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0746\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (52, 68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (52, 68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (51, 67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2946 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2166 (76.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e780 (78.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican American/Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e714 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e551 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.4754\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3508 (92.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2596 (93.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e912 (92.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e268 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (7.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharlson-Deyo Score, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0840\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3118 (80.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2293 (80.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e825 (82.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e505 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e391 (13.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e152 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsurance, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Insured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e261 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e207 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1553 (40.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1132 (40.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e421 (42.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e634 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e453 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e181 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1334 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1003 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e331 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Government\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedian Income Quartiles, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u003cspan\u003e$\u003c/span\u003e46,227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e666 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e521 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e46,227-\u003cspan\u003e$\u003c/span\u003e57,856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e769 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e589 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e180 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e57,587-\u003cspan\u003e$\u003c/span\u003e74,062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e814 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e593 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e221 (22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e74,063 or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1063 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e756 (26.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e307 (30.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e552 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e404 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15.3% or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e799 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e594 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.1%-15.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1018 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e771 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e247 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0%-9.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e911 (23.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e692 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e219 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e598 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e411 (14.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e187 (18.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e538 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e395 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e143 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e500 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e395 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3176 (85.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2335 (84.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e841 (87.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubtype, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER+/PR+/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1012 (26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e724 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e288 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER+/PR(+\u0026thinsp;or -)/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e571 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e424 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER-/PR-/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e492 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e365 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER-/PR-/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e893 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e693 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e896 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e657 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e239 (23.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment Facility Type, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e196 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComprehensive Community Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1377 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1054 (39.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e323 (34.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic/Research Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1259 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e885 (32.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e374 (40.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegrated Network Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e741 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e556 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e185 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2485 (65.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1787 (63.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e698 (70.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1317 (34.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1028 (36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e289 (29.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHormone Therapy, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1507 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1082 (38.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e425 (43.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2291 (60.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1733 (61.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e558 (56.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmunotherapy, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e862 (22.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e595 (20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e267 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2983 (77.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2252 (79.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e731 (73.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBone-Mets at diagnosis, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0671\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2217 (57.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1669 (58.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e548 (55.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1613 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1172 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e441 (44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiver-Mets at diagnosis, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3428\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1136 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e854 (30.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e282 (28.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2662 (70.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1962 (69.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e700 (71.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLung-Mets at diagnosis, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1789 (47.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1366 (48.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e423 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1990 (52.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1437 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e553 (56.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eReceipt of Brain RT and associated survival outcomes:\u003c/h2\u003e \u003cp\u003eThe median OS for the entire cohort of patients with breast cancer brain metastases was 10.9 months (95% CI: 10.4\u0026ndash;11.5), including a 1-year OS rate of 48% (95% CI: 47%-49%) and a 2-year OS rate of 34% ((95% CI: 33%-35%). The Kaplan Meier curve in Supplemental Fig.\u0026nbsp;2 shows that patients who received brain RT had improved survival compared to those not receiving brain radiation (HR 0.89 (95% CI: 0.85\u0026ndash;0.93)) within the first 4 years after treatment. After 4 years, brain radiation no longer conveyed significantly improved survival outcomes, most likely due to the limited number of cases with \u0026gt;\u0026thinsp;4 years survival (Supplemental Table\u0026nbsp;1). Regardless, the median OS for the RT cohort was 12.7 months (95% CI: 11.9\u0026ndash;13.6), significantly longer median OS than the entire cohort.\u003c/p\u003e \u003cp\u003eIn the adjusted model, patients receiving systemic therapy only (HR: 0.40, 95% CI: 0.36\u0026ndash;0.43)) or receipt of both brain RT and systemic therapy (HR: 0.38, 95% CI: 0.35\u0026ndash;0.42) had significantly better survival outcomes than those receiving neither systemic therapy nor brain RT. Moreover, patients who received only brain RT were not significantly associated with improved OS. Patients on systemic therapy alone as well as patients with both brain RT and systemic therapy receipt continued to have better survival, even after 4 years post-diagnosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMultivariable analysis of all patients with BC BM showed that older patients (HR: 1.012, 95% CI: 1.009\u0026ndash;1.016) with more co-morbidities (HR: 1.41, 95% CI: 1.15\u0026ndash;1.74), no insurance (HR: 1.35, 95% CI: 1.19\u0026ndash;1.53) or Medicaid (HR: 1.13, 95% CI: 1.04\u0026ndash;1.24), treatment at community cancer centers (HR: 1.19, 95% CI: 1.05\u0026ndash;1.35) and triple negative (HR: 1.84, 95% CI: 1.69-2.00) or ER-/PR-/Her-2+ (HR: 1.13, 95% CI: 1.02\u0026ndash;1.25) molecular subtypes had increased mortality (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between Receipt of Brain Radiation Therapy for Breast Cancer Brain Metastases and Overall Survival\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude HRs (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdjusted HRs (95% CI)*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-year increase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.020 (1.018\u0026ndash;1.022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.012 (1.009\u0026ndash;1.016)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-year increase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.10 (1.09\u0026ndash;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06 (1.05\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican American/Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.14 (1.08\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.08 (1.00-1.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.79 (0.68\u0026ndash;0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82 (0.68\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68 (0.55\u0026ndash;0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.94 (0.73\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.65 (0.59\u0026ndash;0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71 (0.63\u0026ndash;0.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharlson-Deyo Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.27 (1.19\u0026ndash;1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.17 (1.07\u0026ndash;1.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.55 (1.38\u0026ndash;1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.23 (1.07\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.74 (1.51-2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.41 (1.15\u0026ndash;1.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Insured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.35 (1.23\u0026ndash;1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.35 (1.19\u0026ndash;1.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.12 (1.05\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13 (1.04\u0026ndash;1.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.52 (1.44\u0026ndash;1.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06 (0.98\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Government\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20 (0.91\u0026ndash;1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.17 (0.72\u0026ndash;1.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedian Income Quartiles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u003cspan\u003e$\u003c/span\u003e46,227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.19 (1.11\u0026ndash;1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e46,227-\u003cspan\u003e$\u003c/span\u003e57,856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20 (1.12\u0026ndash;1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e57,587-\u003cspan\u003e$\u003c/span\u003e74,062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.19 (1.11\u0026ndash;1.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e74,063 or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.10 (1.02\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15.3% or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.07 (0.99\u0026ndash;1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.1%-15.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.21 (1.12\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0%-9.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.09 (1.01\u0026ndash;1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.07 (0.98\u0026ndash;1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20 (0.99\u0026ndash;1.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09 (0.88\u0026ndash;1.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.13 (1.06\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.08 (1.00-1.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubtype\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER+/PR+/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER+/PR (+\u0026thinsp;or -)/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.77\u0026ndash;0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.90 (0.82\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER-/PR-/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08 (0.99\u0026ndash;1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13 (1.02\u0026ndash;1.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER-/PR-/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.96 (1.83\u0026ndash;2.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.84 (1.69-2.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.54 (1.45\u0026ndash;1.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.32 (1.22\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment facility type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.26 (1.14\u0026ndash;1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.19 (1.05\u0026ndash;1.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComprehensive Community Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25 (1.18\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21 (1.13\u0026ndash;1.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic/Research Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegrated Network Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25 (1.17\u0026ndash;1.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.26 (1.17\u0026ndash;1.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the cohort of patients that underwent brain radiation (SRS or WBRT), patients undergoing SRS had better survival outcomes compared to patients undergoing WBRT (HR: 0.76, 95% CI: 0.69\u0026ndash;0.83) after adjusting for age, race, ethnicity, CDS, insurance, community, subtype, treatment facility type, chemotherapy, hormone therapy and immunotherapy (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In addition to patients receiving WBRT, older patients (HR: 1.012, 95% CI: 1.006\u0026ndash;1.018) with more co-morbidities (HR: 1.61, 95% CI: 1.24\u0026ndash;2.10), lack of insurance (HR: 1.25, 95% CI: 1.02\u0026ndash;1.53), triple negative molecular subtype (HR: 1.45, 95% CI: 1.20\u0026ndash;1.75) with treatment at comprehensive community cancer centers (HR: 1.24, 95% CI: 1.11\u0026ndash;1.38) had worse survival outcomes in this adjusted model (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between Receipt of Brain Radiation Therapy Type for Breast Cancer Brain Metastases and Overall Survival\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude HRs (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdjusted HRs (95% CI)*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-year increase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.021 (1.018\u0026ndash;1.024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.012 (1.006\u0026ndash;1.018)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-year increase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11 (1.09\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06 (1.03\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican American/Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.17 (1.07\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.14 (0.98\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.74 (0.60\u0026ndash;0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.69 (0.51\u0026ndash;0.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.70 (0.51\u0026ndash;0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98 (0.56\u0026ndash;1.71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.62 (0.53\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74 (0.60\u0026ndash;0.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharlson-Deyo Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.33 (1.20\u0026ndash;1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.18 (1.01\u0026ndash;1.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.57 (1.30\u0026ndash;1.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.33 (1.07\u0026ndash;1.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.85 (1.46\u0026ndash;2.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.61 (1.24\u0026ndash;2.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Insured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.32 (1.15\u0026ndash;1.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.25 (1.02\u0026ndash;1.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04 (0.94\u0026ndash;1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13 (0.99\u0026ndash;1.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.55 (1.43\u0026ndash;1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.16 (1.01\u0026ndash;1.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Government\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.34 (0.83\u0026ndash;2.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11 (0.53\u0026ndash;2.34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedian Income Quartiles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u003cspan\u003e$\u003c/span\u003e46,227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.24 (1.12\u0026ndash;1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e46,227-\u003cspan\u003e$\u003c/span\u003e57,856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.32 (1.18\u0026ndash;1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e57,587-\u003cspan\u003e$\u003c/span\u003e74,062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25 (1.13\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e74,063 or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.18 (1.06\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15.3% or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20 (1.07\u0026ndash;1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.1%-15.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.23 (1.10\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0%-9.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.15 (1.03\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.16 (1.02\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.18 (0.90\u0026ndash;1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.20 (0.88\u0026ndash;1.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.21 (1.09\u0026ndash;1.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06 (0.91\u0026ndash;1.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubtype\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER+/PR+/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER+/PR (+\u0026thinsp;or -)/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73 (0.66\u0026ndash;0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96 (0.79\u0026ndash;1.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER-/PR-/HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.99 (0.88\u0026ndash;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.08 (0.89\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER-/PR-/HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.81 (1.64\u0026ndash;2.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.45 (1.20\u0026ndash;1.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.37 (1.24\u0026ndash;1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.27 (1.11\u0026ndash;1.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment facility type\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.36 (1.16\u0026ndash;1.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.20 (0.94\u0026ndash;1.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComprehensive Community Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.33 (1.22\u0026ndash;1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.24 (1.11\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic/Research Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegrated Network Cancer Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.26 (1.14\u0026ndash;1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.22 (1.07\u0026ndash;1.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.54 (0.50\u0026ndash;0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.58 (0.52\u0026ndash;0.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHormone therapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67 (0.63\u0026ndash;0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.61 (0.54\u0026ndash;0.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmunotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.51 (0.47\u0026ndash;0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.64 (0.56\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Brain Radiation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhole Bran Radiation Therapy (WBRT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStereotactic Radiosurgery (SRS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.79 (0.72\u0026ndash;0.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76 (0.69\u0026ndash;0.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe diagnosis of breast cancer brain metastases remains a devastating event for patients, yet multi-disciplinary treatment approaches including SRS and CNS-penetrating systemic therapies continues to improve survival outcomes while minimizing toxicity. However, there is no standard treatment for breast cancer brain metastases, particularly for brain radiation and its integration of systemic therapy.\u003c/p\u003e \u003cp\u003eYounger patients with triple negative breast cancers were more likely to receive radiation. Similarly, patients who underwent systemic therapy, specifically chemotherapy and immunotherapy, were more likely to undergo brain radiation. These trends reflect more comprehensive treatment in patients with good performance status and aggressive breast cancers. Older patients, particularly those with ER\u0026thinsp;+\u0026thinsp;BM and those with Medicare, were less likely to receive brain radiation. This may be explained by patient preference for less aggressive treatment or hospice based on their age or declining functional status at the time of brain metastases diagnosis. However, it is important to note that our previously published study showed that older patients\u0026thinsp;\u0026gt;\u0026thinsp;65 yo tolerated stereotactic radiation with excellent outcomes and that age alone should not dictate treatment decisions\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eInterestingly, there were no statistically significant associations between receipt of brain radiation (either WBRT or SRS) and race, ethnicity, education, community type, or type of treatment facility. This suggests that access to routine whole brain radiation appears to be more equitable across sociodemographic groups than SRS. African American patients, those with lower median income, urban location, triple negative molecular subtype and community treatment facilities were more likely to receive WBRT compared to SRS. In contrast, White patients, those with higher median income treated at academic facilities were more likely to undergo SRS compared to WBRT. Despite the shifting paradigm toward increased utilization of SRS over the past 20 years (Supplemental Fig.\u0026nbsp;2), the specialized technical expertise and equipment necessary for stereotactic brain treatments are not readily accessible to all patients. Indeed, only a minority of patients (~\u0026thinsp;35%) diagnosed with BC BM in 2020 that received radiation underwent SRS (Supplemental Fig.\u0026nbsp;2). These findings align with those reported by Kann et al., whose retrospective analysis of NCDB data revealed that non-White race and non-private insurance was associated with lower use of SRS for brain metastases from a variety of primary cancers.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e These results are also consistent with Mainwaring et al\u003csup\u003e7\u003c/sup\u003e that highlight barriers to accessing SRS. We similarly show that WBRT remains more prevalent than SRS over the period of our study.\u003c/p\u003e \u003cp\u003eWhile systemic therapy is considered the primary driver of survival outcomes in metastatic breast cancer, the survival benefit from brain radiation remains uncertain. The Quartz Trial, one of the only randomized clinical trials comparing brain radiation (WBRT) versus supportive care in metastatic NSCLC patients, found no survival benefit to whole brain radiation. However, it is important to note that patients included in the Quartz trial had poor prognosis and performance status\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Moreover, the multi-institutional retrospective analysis by Pike et al. (2024) showed patients with metastatic NSCLC to the brain that underwent treatment with tyrosine kinase inhibitors +/- SRS showed no apparent survival advantage with the up-front use of radiosurgery, however did show increased local control with SRS in metastases\u0026thinsp;\u0026gt;\u0026thinsp;1 cm.\u003csup\u003e13\u003c/sup\u003e Similarly, our study suggests no independent survival benefit from brain radiation when adjusting for systemic therapy on MVA.\u003c/p\u003e \u003cp\u003eOur multivariable analysis showed that younger patients with fewer co-morbidities, private insurance, and treatment at academic institutions had improved survival. Improved survival outcomes for breast cancer patients with brain metastases treated at academic institutions may be attributed to the comprehensive multi-disciplinary approach facilitated by tumor boards and specialized clinics. These settings enable integrated decision-making involving Radiation Oncology, Medical Oncology, Neurosurgery, Neuro Oncology, Neuroradiology leading to tailored treatment plans that optimize the use of CNS penetrating systemic therapies and their integration with radiation.\u003c/p\u003e \u003cp\u003eOur study showed that patients with more aggressive triple negative and Her-2\u0026thinsp;+\u0026thinsp;molecular subtypes had worse outcomes. However, it is important to note that many of these patients were diagnosed before the FDA approval of CNS-penetrating systemic therapies in 2020, including tucatinib, fam-trastuzumab deruxtecan and Sacituzumab govitecan, which have shown improved survival outcomes in Her-2\u0026thinsp;+\u0026thinsp;and triple negative breast cancer patients, respectively.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. While OS of patients with BC BM has significantly improved between 2010\u0026ndash;2020 (Supplemental Fig.\u0026nbsp;3), survival outcomes for HER2-positive and triple negative patients are likely to continue to improve as the NCDB incorporates more recent data following the recent FDA approvals of CNS-penetrating systemic therapies. Moreover, patients who underwent systemic therapy (chemotherapy, immunotherapy or hormone therapy) in addition to brain radiation had better survival, further reinforcing that systemic therapy drives prognosis.\u003c/p\u003e \u003cp\u003eInterestingly, patients receiving SRS had a lower risk of death (24%) compared to those receiving whole brain radiation. This finding is inconsistent with previous randomized clinical trials demonstrating that SRS and WBRT result in similar OS outcomes. While SRS results in excellent local control outcomes and improved quality of life, WBRT results in improved intracranial progression free survival (PFS) without an OS benefit.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e We acknowledge that this discrepancy is most likely due to selection bias in our retrospective study as patients receiving whole brain radiation typically have higher burden of CNS disease and worse prognosis, while SRS is often reserved for patients with \u0026ldquo;limited\u0026rdquo; brain metastases and better performance status. A major limitation of NCDB studies is that NCDB does not capture details on extent of brain metastases (number and volume), brain metastases velocity, intracranial progression free survival or presence of leptomeningeal disease, which limited our ability to fully elucidate treatment rationales and better understand survival outcomes. Unfortunately, data on quality of life and neurocognitive function are also not available in the NCDB database.\u003c/p\u003e \u003cp\u003eIn conclusion, our study highlights disparities in breast cancer brain metastases treatment, particularly in treatment patterns and access to stereotactic radiation. SRS offers quality of life benefits that are critical as newer CNS penetrating systemic therapies prolong survival for these patients. While a major limitation of this study is that NCDB does not capture data on symptoms, extent of disease and QOL outcomes, it does demonstrate that efforts to improve access to SRS are essential. Prospective trials evaluating SRS in the context of modern CNS-penetrating systemic therapies and corresponding QOL outcomes are needed to establish evidence-based standards for BCBM across all sociodemographic groups.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eT.P. and S. B. wrote the manuscriptY.G and B.S. performed the statistics and prepared the figures and tablesAll other authors analyzed the data and reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData are available in the National Cancer Database (NCDB) upon request at https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVogelbaum MA, Brown PD, Messersmith H, et al. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline. \u003cem\u003eJCO\u003c/em\u003e. 2022;40(5):492-516. doi:10.1200/JCO.21.02314\u003c/li\u003e\n\u003cli\u003eGomez D, Feng JJ, Cheok S, et al. Incidence of brain metastasis according to patient race and primary cancer origin: a systematic review. \u003cem\u003eJ Neurooncol\u003c/em\u003e. 2024;169(3):457-467. doi:10.1007/s11060-024-04748-6\u003c/li\u003e\n\u003cli\u003eSchootman M, Jeffe DB, Gillanders WE, Aft R. Racial disparities in the development of breast cancer metastases among older women: a multilevel study. \u003cem\u003eCancer\u003c/em\u003e. 2009;115(4):731-740. doi:10.1002/cncr.24087\u003c/li\u003e\n\u003cli\u003eWu J, Ye J, Wu W, et al. Racial disparities in young-onset patients with colorectal, breast and testicular cancer. \u003cem\u003eJ Cancer\u003c/em\u003e. 2019;10(22):5388-5396. doi:10.7150/jca.32435\u003c/li\u003e\n\u003cli\u003eRen JX, Gong Y, Ling H, Hu X, Shao ZM. Racial/ethnic differences in the outcomes of patients with metastatic breast cancer: contributions of demographic, socioeconomic, tumor and metastatic characteristics. \u003cem\u003eBreast Cancer Res Treat\u003c/em\u003e. 2019;173(1):225-237. doi:10.1007/s10549-018-4956-y\u003c/li\u003e\n\u003cli\u003eKann BH, Park HS, Johnson SB, Chiang VL, Yu JB. Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States. \u003cem\u003eJ Natl Compr Canc Netw\u003c/em\u003e. 2017;15(12):1494-1502. doi:10.6004/jnccn.2017.7003\u003c/li\u003e\n\u003cli\u003eMainwaring W, Bowers J, Pham N, et al. Stereotactic Radiosurgery Versus Whole Brain Radiation Therapy: A Propensity Score Analysis and Predictors of Care for Patients With Brain Metastases From Breast Cancer. \u003cem\u003eClin Breast Cancer\u003c/em\u003e. 2019;19(2):e343-e351. doi:10.1016/j.clbc.2018.11.001\u003c/li\u003e\n\u003cli\u003eLi F. Balancing Covariates via Propensity Score Weighting: Journal of the American Statistical Association: Vol 113, No 521. Accessed July 3, 2025. https://www.tandfonline.com/doi/abs/10.1080/01621459.2016.1260466\u003c/li\u003e\n\u003cli\u003eThomas LE, Li F, Pencina MJ. Overlap Weighting: A Propensity Score Method That Mimics Attributes of a Randomized Clinical Trial. \u003cem\u003eJAMA\u003c/em\u003e. 2020;323(23):2417. doi:10.1001/jama.2020.7819\u003c/li\u003e\n\u003cli\u003eAustin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. \u003cem\u003eMultivariate Behav Res\u003c/em\u003e. 2011;46(3):399-424. doi:10.1080/00273171.2011.568786\u003c/li\u003e\n\u003cli\u003eUpadhyay R, Klamer BG, Perlow HK, et al. Stereotactic Radiosurgery for Women Older than 65 with Breast Cancer Brain Metastases. \u003cem\u003eCancers (Basel)\u003c/em\u003e. 2023;16(1):137. doi:10.3390/cancers16010137 \u003c/li\u003e\n\u003cli\u003eMulvenna P, Nankivell M, Barton R, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. \u003cem\u003eThe Lancet\u003c/em\u003e. 2016;388(10055):2004-2014. doi:10.1016/S0140-6736(16)30825-X\u003c/li\u003e\n\u003cli\u003ePike LRG, Miao E, Boe LA, et al. Tyrosine Kinase Inhibitors With and Without Up-Front Stereotactic Radiosurgery for Brain Metastases From EGFR and ALK Oncogene-Driven Non-Small Cell Lung Cancer (TURBO-NSCLC). \u003cem\u003eJ Clin Oncol\u003c/em\u003e. 2024;42(30):3606-3617. doi:10.1200/JCO.23.02668\u003c/li\u003e\n\u003cli\u003eSaura C, Modi S, Krop I, et al. Trastuzumab deruxtecan in previously treated patients with HER2-positive metastatic breast cancer: updated survival results from a phase II trial (DESTINY-Breast01). \u003cem\u003eAnn Oncol\u003c/em\u003e. 2024;35(3):302-307. doi:10.1016/j.annonc.2023.12.001\u003c/li\u003e\n\u003cli\u003eAndr\u0026eacute; F, Park YH, Kim SB, et al. Trastuzumab deruxtecan versus treatment of physician\u0026rsquo;s choice in patients with HER2-positive metastatic breast cancer (DESTINY-Breast02): a randomised, open-label, multicentre, phase 3 trial. \u003cem\u003eThe Lancet\u003c/em\u003e. 2023;401(10390):1773-1785. doi:10.1016/S0140-6736(23)00725-0\u003c/li\u003e\n\u003cli\u003eCort\u0026eacute;s J, Kim SB, Chung WP, et al. Trastuzumab Deruxtecan versus Trastuzumab Emtansine for Breast Cancer. \u003cem\u003eNew England Journal of Medicine\u003c/em\u003e. 2022;386(12):1143-1154. doi:10.1056/NEJMoa2115022\u003c/li\u003e\n\u003cli\u003eMurthy RK, Loi S, Okines A, et al. Tucatinib, Trastuzumab, and Capecitabine for HER2-Positive Metastatic Breast Cancer. \u003cem\u003eNew England Journal of Medicine\u003c/em\u003e. 2020;382(7):597-609. doi:10.1056/NEJMoa1914609\u003c/li\u003e\n\u003cli\u003eBrown PD, Ballman KV, Cerhan JH, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC\u0026middot;3): a multicentre, randomised, controlled, phase 3 trial. \u003cem\u003eThe Lancet Oncology\u003c/em\u003e. 2017;18(8):1049-1060. doi:10.1016/S1470-2045(17)30441-2\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"breast-cancer-research-and-treatment","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"brea","sideBox":"Learn more about [Breast Cancer Research and Treatment](https://www.springer.com/journal/10549)","snPcode":"10549","submissionUrl":"https://submission.nature.com/new-submission/10549/3","title":"Breast Cancer Research and Treatment","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"breast cancer, brain metastases, stereotactic radiation, whole brain radiation, metastatic breast cancer","lastPublishedDoi":"10.21203/rs.3.rs-8545320/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8545320/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBreast cancer (BC) brain metastases (BM) treatment involves radiotherapy (RT), surgery, and CNS-penetrating systemic therapies. This study evaluated treatment patterns in brain RT and corresponding survival outcomes among patients with BC BM using the National Cancer Database (NCDB).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePatients diagnosed with BC BM between 2010\u0026ndash;2020 were identified. RT was categorized as whole brain (WBRT) vs. stereotactic (SRT). We fitted Overlap Propensity Score Weighting (OPSW) Cox models to account for confounders affecting OS. Variables included age, race, ethnicity, Charlson-Deyo score, insurance, molecular subtype, facility type, and systemic therapy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOf 8,909 patients with BC BM, 43.4% received brain RT (74.1% WBRT, 25.9% SRS). Patients receiving RT tended to be younger, privately insured, triple-negative subtype, and received systemic therapy (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no significant associations with race, ethnicity, education, or facility. However, patients that are African American, lower income, urban, triple-negative, or at community facilities were more likely to receive WBRT over SRS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Median OS was 10.9 months (95% CI: 10.4\u0026ndash;11.5). Systemic therapy alone (HR 0.40, 95% CI: 0.36\u0026ndash;0.43) or combined with RT (HR 0.38, 95% CI: 0.35\u0026ndash;0.42) improved OS, however RT alone did not improve survival on MVA (HR 0.96 (95% CI: 0.91\u0026ndash;1.02). Among RT recipients, SRS was associated with improved OS vs. WBRT (HR 0.76, 95% CI: 0.69\u0026ndash;0.83). Older age, comorbidities, lack of insurance, community facilities, and aggressive subtypes were associated with worse OS.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTreatment patterns, particularly access to SRS, differ among BC BM patients. More prospective trials are needed to establish evidence-based treatment standards.\u003c/p\u003e","manuscriptTitle":"Radiation Treatment Patterns for Breast Cancer Brain Metastases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 07:27:18","doi":"10.21203/rs.3.rs-8545320/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-17T18:38:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T17:12:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T02:39:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T09:11:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90517296016604248655847231894835249160","date":"2026-02-06T00:36:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156833178808257291441498863491775785267","date":"2026-02-04T00:03:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153974266885407372351293657707536044934","date":"2026-02-03T18:26:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127999300984449132204311368247729477938","date":"2026-02-03T17:13:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-03T16:59:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-08T08:45:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-08T08:44:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Breast Cancer Research and Treatment","date":"2026-01-07T21:48:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"breast-cancer-research-and-treatment","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"brea","sideBox":"Learn more about [Breast Cancer Research and Treatment](https://www.springer.com/journal/10549)","snPcode":"10549","submissionUrl":"https://submission.nature.com/new-submission/10549/3","title":"Breast Cancer Research and Treatment","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9368ad86-e7c3-48c7-a3f8-98143ecb8f2e","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:12:34+00:00","versionOfRecord":{"articleIdentity":"rs-8545320","link":"https://doi.org/10.1007/s10549-026-07955-z","journal":{"identity":"breast-cancer-research-and-treatment","isVorOnly":false,"title":"Breast Cancer Research and Treatment"},"publishedOn":"2026-04-22 15:59:06","publishedOnDateReadable":"April 22nd, 2026"},"versionCreatedAt":"2026-02-09 07:27:18","video":"","vorDoi":"10.1007/s10549-026-07955-z","vorDoiUrl":"https://doi.org/10.1007/s10549-026-07955-z","workflowStages":[]},"version":"v1","identity":"rs-8545320","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8545320","identity":"rs-8545320","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}