Adrenal Metastasis From Hepatocellular Carcinoma: Radiofrequency Ablation Combined With Adrenal Arterial Chemoembolization in Six Patients

Yamakado, Koichiro; Anai, Hiroshi; Takaki, Haruyuki; Sakaguchi, Hiroshi; Tanaka, Toshihiro; Kichikawa, Kimihiko; Takeda, Kan

doi:10.2214/ajr.08.1752

Cited by 55 publications

(52 citation statements)

References 27 publications

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“…Our current analyses indicated that resection of metastatic lesions produced a satisfactory local response, consistent with previous reports. [32][33][34][35][36] Locoregional therapy for extrahepatic metastasis also was discussed in earlier studies, including irradiation for bone, 37 lymph node, 38 brain, 39 and adrenal 40 metastases; TACE for adrenal metastasis 41 ; and percutaneous ablation for adrenal 42 and bone metastases. 43 We also used these methods to treat some patients in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma with extrahepatic metastasis

Uchino

Tateishi

Shiina

et al. 2011

Cancer

377

322

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BACKGROUND: Despite significant advances in the treatment of intrahepatic lesions, the prognosis for patients with hepatocellular carcinoma (HCC) who have extrahepatic metastasis remains poor. The objective of this study was to further elucidate the clinical course and prognostic determinants of patients with this disease. METHODS: In total, 342 patients who had HCC with extrahepatic metastasis were enrolled. The metastases were diagnosed at initial presentation with HCC in 28 patients and during follow-up in the remaining patients. The authors analyzed clinical features, prognoses, and treatments and established a scoring system to predict prognosis using a split-sample method with a testing set and a training set. RESULTS: The most frequent site of extrahepatic metastasis was the lung followed by lymph nodes, bone, and adrenal glands. These metastases were related directly to death in only 23 patients (7.6%). The median survival after diagnosis of extrahepatic metastasis was 8.1 months (range, 0.03-108.7 months). In univariate analysis of the training set (n ¼ 171), performance status, Child-Pugh classification, the number and size of intrahepatic lesions, macroscopic vascular invasion, symptomatic extrahepatic metastases, a-fetoprotein levels, and complete responses to treatment were associated significantly with prognosis. On the basis of multivariate analysis, a scoring system was developed to predict prognosis that assessed uncontrollable intrahepatic lesions, extent of vascular invasion, and performance status. This scoring system was validated in the testing set (n ¼ 171) and produced a concordance index of 0.73. CONCLUSIONS: The controllability of intrahepatic lesions and performance status were identified as important prognostic factors in patients with advanced HCC who had extrahepatic metastasis. Cancer 2011;117:4475-

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Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma with extrahepatic metastasis

Uchino

Tateishi

Shiina

et al. 2011

Cancer

377

322

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“…Yamakado et al 75 reported on 6 patients with 8 adrenal HCC metastases that were managed with combinedmodality therapy. All patients either were not surgical candidates or refused surgery.…”

Section: Arterial Embolizationmentioning

confidence: 99%

Management of Isolated Adrenal Lesions in Cancer Patients

McLean

Lilienfeld²,

Caracciolo³

et al. 2011

Cancer Control

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“…Treatments for adrenal metastases and otherwise limited metastatic disease were previously limited to adrenalectomy, radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), or systemic therapy (3,4). In a metaanalysis of 114 patients with non-small cell lung cancer undergoing resection of adrenal metastases, the 5-year overall survival was 25-26%, suggesting that there can be long-term survivors in this group of patients (5).…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Curative Treatment of Adrenal Metastases

Rudra

Malik

Ranck

et al. 2013

Technol Cancer Res Treat

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The detection of oligometastatic adrenal metastases is increasing and there are limited data supporting the use of curative intent stereotactic body radiation therapy (SBRT) to treat patients with limited metastatic disease with adrenal involvement. Therefore, we utilized a prospectively maintained database of consecutive patients treated with SBRT for limited metastatic disease (5 sites) to identify patients with adrenal metastases. Patients were either treated on a three-fraction dose escalation protocol or a ten fraction off-protocol regimen.Outcomes including treated-metastasis control (TMC), distant control (DC), and overall survival (OS) were calculated by the Kaplan-Meier method. Ten patients with 13 adrenal metastases were identified for this case series. The median follow-up was 14.9 months. No patient experienced grade 3 toxicity. The most common grade 1-2 acute toxicities were fatigue (80%) and GI toxicity (40%). One patient experienced late grade 2 adrenal insufficiency. Overall, the 1-year TMC rate was 73%, DC was 30%, and OS was 90%. Three treated adrenal metastases progressed, all receiving the lowest BED 10 (43.2 Gy), corresponding to 24 Gy in 3 fractions.After treatment of adrenal metastases with SBRT, the median time to salvage chemotherapy was 5.3 months (range 1.0-38.8 months) and 1-year freedom from salvage chemotherapy was 44%. These results suggest that SBRT to adrenal metastases was tolerated with low toxicity in limited metastatic patients and control rates are promising. This study supports the growing body of literature treating patients with adrenal metastases with SBRT.

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Adrenal Metastasis From Hepatocellular Carcinoma: Radiofrequency Ablation Combined With Adrenal Arterial Chemoembolization in Six Patients

Abstract: The combination therapy described is a safe multidisciplinary therapeutic option that can lengthen survival among patients with adrenal metastasis from hepatocellular carcinoma.

Cited by 55 publications

References 27 publications

Hepatocellular carcinoma with extrahepatic metastasis

Hepatocellular carcinoma with extrahepatic metastasis

Management of Isolated Adrenal Lesions in Cancer Patients

Stereotactic Body Radiation Therapy for Curative Treatment of Adrenal Metastases

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