Treatment of Adrenal Metastases with Conventional or Hypofractionated Image-guided Radiation Therapy – Patterns and Outcomes

Buergy, Daniel; Rabe, Leonie; Siebenlist, Kerstin; Stieler, Florian; Fleckenstein, Jens; Giordano, Frank A.; Wenz, Frederik; Boda-Heggemann, Judit

doi:10.21873/anticanres.12788

Cited by 24 publications

(33 citation statements)

References 16 publications

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“…In our study, no late gastrointestinal or renal toxicities were found, which was consistent with the previous studies [ 25 – 28 ]. Only two patients developed multiple gastric or duodenal ulcer [ 25 ].…”

Section: Discussionsupporting

confidence: 93%

“…Similar outcomes were also found in Franzese et al with the median OS of 28.5 months and 1-year and 2-year LC rates of 65.5% and 40.7%, respectively [ 27 ]. Nevertheless, the median OS was inferior than those in the above studies when patients received SBRT or conventional radiotherapy [ 28 ], which might be attributable to lower BED 10 compared with those of SBRT. The findings in current study were consistent with previous studies.…”

Section: Discussionmentioning

confidence: 96%

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Short-term outcomes and clinical efficacy of stereotactic body radiation therapy (SBRT) in treatment of adrenal gland metastases from lung cancer

et al. 2018

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BackgroundTo assess the efficacy and safety of stereotactic body radiation therapy (SBRT) in the management of adrenal gland metastases (AGMs) from lung cancer. Moreover, it is the first two-institutional experience and the largest-to-date study to report the safety and efficacy of SBRT for inoperable AGM from lung cancer.MethodsIn this retrospective study, 30 patients (27 males, 3 females) with 32 AGMs were treated by SBRT from October 2006 to June 2016. Of these, 11 patients were treated with the intent of controlling all known metastatic sites and 19 for palliation of bulky AGMs. Follow-up was performed every 3 months for evaluations of efficacy and safety. Factors predictive of overall survival (OS) and local control (LC) were identified with univariate and then multivariate analysis.ResultsMedian follow-up time was 10.7 months (2.9–96.4 months). The complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) rates were 23.3%, 33.3%, 33.3% and 16.7% respectively. The 6-month, 1, and 2-year LC rates were 96.9%, 96.9%, and 72.7% respectively. Additionally, the 6-month, 1, and 2-year OS rates were 85.6%, 58.1%, and 54.0% respectively while 6-month, 1, and 2-year progression free survival (PFS) rates were 39.5%, 24.6%, and 8.2%, respectively. All the patients with cancer-induced pain (8 with abdominal pain and 6 with lumbar back pain) had significant alleviations after SBRT. The treatment was well tolerated with only 1 patient reporting grade-3 diarrhoea. No predictors of OS and LC were found after multivariate analysis, while it was demonstrated that biologic equivalent dose (BED10, α/β = 10) ≥85.5Gy (P = 0.007) and gross tumor volume < 30 ml (P = 0.003) correlated with LC only after univariate analysis.ConclusionSBRT is a safe and effective treatment modality in the management of AGMs from lung cancer with high LC rates and acceptable toxicity.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 96%

Short-term outcomes and clinical efficacy of stereotactic body radiation therapy (SBRT) in treatment of adrenal gland metastases from lung cancer

et al. 2018

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“…Limitations to this study were mainly caused by the retrospective nature of this analysis. Patient numbers were rather low, but similar to other studies, as adrenal SBRT is still not offered to many patients [3,21,22,24,36,43,45]. Furthermore, for increasing strength and homogeneity of our study, we only focused our analysis on truly oligometastatic or oligoprogressive patients and excluded all patients who were treated with palliative intent or dose.…”

Section: Discussionmentioning

confidence: 96%

“…While SBRT is well established and widely applied in the treatment of pulmonary and hepatic oligometastases [17][18][19][20], the literature for adrenal metastases is scarce. Predominantly small and retrospective studies exist which do not primarily focus on oligometastatic or oligoprogressive disease, but also include patients treated with palliative intent [21][22][23][24][25][26][27]. Furthermore, these studies only report limited details on radiotherapy planning and requirement for forced dose restrictions due to the close proximity to radiosensitive organs-at risks (OARs).…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

et al. 2020

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Introduction: Local ablative treatment strategies are frequently offered to patients diagnosed with oligometastatic disease. Stereotactic body radiotherapy (SBRT), as ablative treatment option, is well established for lung and liver metastases, whereas for isolated adrenal gland metastases the level of evidence is scarce. Material and methods: This single-institution analysis of oligometastatic or oligoprogressive disease was limited to patients who received SBRT to adrenal metastasis between 2012 and 2019. Patient, tumor, treatment characteristics, and dosimetric parameters were analyzed for evaluation of their effect on survival outcomes. Results: During the period of review 28 patients received ablative SBRT to their adrenal gland metastases. Most common primary tumors were non-small cell lung cancers (46%) with most patients diagnosed with a single adrenal gland metastasis (61%), which occurred after a median time of 14 months. SBRT was delivered to a median biological effective dose at α/β of 10 (BED 10) of 75 Gy (range: 58-151 Gy). Median gross tumor volume (GTV) and median planning target volume (PTV) were 42 and 111 mL, respectively. The homogeneity and conformity indices were 1.17 (range: 1.04-1.64) and 0.5 (range: 0.4.0.99), respectively, with the conformity index being affected by dose restrictions to organs at risk (OARs) in 50% of the patients. Overall response rate based on RECIST criteria was 86% (CR = 29%, PR = 57%) with 2-year local control (LC) of 84.8%, 2-year progression-free survival (PFS) of 26.3%, and 1and 2-year overall survival (OS) of 46.6 and 32.0%, respectively. During follow up, only two local recurrences occurred. A trend for superior LC was seen if BED 10 was ≥75Gy (p = 0.101) or if the PTV was < 100 ml (p = 0.072). SBRT was tolerated well with only mild toxicity. Conclusion: SBRT for adrenal metastases resulted in promising LC with low toxicity. Treatment response appeared to be superior, if SBRT was applied with higher BED. As the close proximity of OARs often limits the application of sufficiently high doses, further dose escalations strategies and techniques should be investigated in future.

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“…After 16 months a local control of 86.7% was seen and no toxicity greater or equal to grade 3 [18]. Buergy et al also report an average local disease-free survival of 18.3 months [19].…”

Section: Discussionmentioning

confidence: 87%

Breath-hold versus mid-ventilation in SBRT of adrenal metastases

Kuijer

Egmond

Kouwenhoven

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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To improve local control in radiotherapy of adrenal metastases precise dose delivery without increasing toxicity is vital. Decreasing the Clinical Target Volume (CTV)-Planning Target Volume (PTV) margins by reducing breathing movement can achieve this. Few data were published concerning the effect of a breath-hold technique. This study investigates the potential of Active Breathing Control (ABC) to limit adrenal breathing movement and reduce CTV-PTV margins. Methods: We compared adrenal gland movement in free-breathing, making use of the Mid-ventilation (MidV) technique, and with ABC. The coordinates of the adrenal glands obtained on ten phases of a free breathing 4D-CT and on several repeat inspiration ABC CT-scans were measured. Separate coordinates, the random margin component and the margin vector norm were computed and compared between the two techniques. Results: We compared the two techniques in 11 patients (21 adrenal glands) and found the largest movement in the Z-direction, with values of 8.7 ± 4.2 mm for MidV and 2.4 ± 1.5 mm for ABC. In 71% of the cases ABC resulted in a smaller margin component than MidV, although non-significant (p ! 0.4). Conclusion: Movement of the adrenal gland is largest in the Z-direction. The mean difference in the margin vector norm between both techniques was small with large variations over the patient group, the clinical effect of these differences is unknown. Applying an individualised motion management strategy could be beneficial. If a peak-to-peak amplitude above 15 mm in the Z-direction is observed in the MidV scan we advise to examine if a breath-hold technique could reduce margins.

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Treatment of Adrenal Metastases with Conventional or Hypofractionated Image-guided Radiation Therapy – Patterns and Outcomes

Abstract: Stereotactic radiotherapy of adrenal metastases was safe and effective in patients with oligometastases or oligoprogression. In palliative patients, short-course radiotherapy complemented with supportive care should be preferred.

Cited by 24 publications

References 16 publications

Short-term outcomes and clinical efficacy of stereotactic body radiation therapy (SBRT) in treatment of adrenal gland metastases from lung cancer

Short-term outcomes and clinical efficacy of stereotactic body radiation therapy (SBRT) in treatment of adrenal gland metastases from lung cancer

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

Breath-hold versus mid-ventilation in SBRT of adrenal metastases

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