Adrenal Oligometastases Secondary to Non-small Cell Lung Cancer—What is the Optimal Treatment Approach?

Thomsen, Bryce; Fairchild, Alysa

doi:10.17925/ohr.2017.13.02.117

Cited by 5 publications

(5 citation statements)

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“…With the widespread use of regularly performed staging with CT or positron-emission-tomography (PET)-CT, and the growing recognition of the oligometastatic or oligoprogressive state in different tumor entities, the number of patients presenting with asymptomatic adrenal metastases has increased [32][33][34]. For these patients, surgical resection remains the gold standard, however, many patients are medically unfit for surgery, or their tumors are not technically resectable, and alternative local treatment approaches are required [4,16,35]. As the current literature on adrenal SBRT is still limited, a patterns-of-care analysis for patients treated with hypofractionated radiotherapy to their adrenal metastases was conducted.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Patients with good performance status can undergo surgery, and some studies have shown prolonged lifespan after adrenalectomy [4,6,24]. However, most patients do not have a level of performance that can support surgical treatment, and surgery cannot be performed for reasons such as location and tumor size [21,25,26]. In the review studies comparing radiosurgery to adrenalectomy, it should not be forgotten that SABR patients are generally patients with worse prognostic factors (2-year OS 44% vs 19%) [27].…”

Section: Discussionmentioning

confidence: 99%

Organ At Risk (OAR) Data on Clinical Toxicity in The Treatment of Bulky Adrenal Metastases With Stereotactic Ablative Radiotherapy (SABR)

Berber

Gürsel

Yıldırım

et al. 2022

Preprint

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Aim: In this study, the effectiveness of the treatment was investigated in terms of treatment responses and side effects with OAR in oligometastatic patients whose adrenal metastases were treated with stereotactic ablative radiotherapy. Methods: Medically inoperable patients who underwent radiosurgery for adrenal gland metastasis in our clinic between 2013 and 2019 were evaluated retrospectively withfor the patient, tumor, treatment characteristics, survival outcomes, and dosimetric parameters with toxicity.Results: Of the 22 patients in our study, 17 were male and 5 were female, with the median age of 63 (RangeRange (R): 41-81) years. PrimaryThe primary tumor site was the lung in 20 (90.9%) of 22 patients, while ten (45.5%) of the patients had isolated adrenal metastasis. The median dose was 30 Gy (R: 18-50) with a median fraction of five (R: 3-10). MedianThe median PTV volume was 55 cc. (IQR(interquartile range): 44-120cc).Conformity120 cc). The conformity index (CI) was 1.15 (R: 0.94-1.55), the homogeneity index (HI) was 1.27 (R: 0.7-1.47), and the coverage was 97.87% (33.33-99.04). From the first diagnosis to adrenal gland radiotherapy, the median time was 6.9 (IQR: 0.5-14) months. The median follow-up was 7 months (R: 2-48), and the median survival was 9.5 months (R: 2-48). The local control rate was 72.7% in the 6th month, 63.6% in the 1st year, and 59.0% in the 2nd year, and overall survival was 72.7%, 50%, and 31.8%, respectively. The median overall survival was 9.5 months for all patients (p= 0.049) and 6.5 months in the presence of diffuse disease. Deaths of patients due to distant progression were also found to be significant (p = 0.03, which was significant). Patients with isolated adrenal metastasis survived for 14.4 months after the treatment; while extra-adrenal metastasis lived for a median of 6.6 months (P = 0.01). Patients without distant progression survived for 16.7 months, and those with distant progression survived for a median of 8.7 months. Treatment-related toxicity grade 3-4 developed in 2 patient patients in which this toxicity was related to the gastrointestinal system. No grade 3 toxicity was detected in the kidney.Conclusion: Maintaining the local control of the adrenal gland metastasis in patients with oligometastatic disease not only provides symptom control, but may also provide prolonged survival with minimal toxicity.

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Section: Discussionmentioning

confidence: 99%

Organ At Risk (OAR) Data on Clinical Toxicity in The Treatment of Bulky Adrenal Metastases With Stereotactic Ablative Radiotherapy (SABR)

Berber

Gürsel

Yıldırım

et al. 2022

Preprint

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Aim Effectiveness of the treatment was investigated in terms of treatment responses and side effects with OAR in oligometastatic patients whose adrenal metastases were treated with SABR. Methods Patients who underwent radiosurgery for adrenal gland metastasis in our clinic were evaluated retrospectively for the patient, tumor, treatment characteristics, survival outcomes, and dosimetric parameters with toxicity. Results Of the 22 patients in our study. The primary tumor site was the lung in 20 (90.9%) of 22 patients, while ten (45.5%) of the patients had isolated adrenal metastasis. The median dose was 30 Gy (R:18–50) with a median fraction of five (R:3–10). The median PTV volume was 55 cc. (IQR:44-120cc). From the first diagnosis to adrenal gland radiotherapy, the median time was 6.9 months. The median follow-up was 7 months (R:2–48), and the median survival was 9.5 months (R:2–48). The local control rate was 72.7% in the 6th month, 63.6% in the 1st year, and 59.0% in the 2nd year, and overall survival was 72.7%, 50%, and 31.8%, respectively. The median overall survival was 9.5 months for all patients (p = 0.049) and 6.5 months in the presence of diffuse disease. Deaths of patients due to distant progression were also found to be significant (p = 0.03). Patients with isolated adrenal metastasis survived for 14.4 months after the treatment; while extra-adrenal metastasis lived for a median of 6.6 months (P = 0.01). Conclusion SABR in patients with oligometastatic adrenal disease not only provides symptom control but may also provide prolonged survival with minimal toxicity.

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Adrenal Oligometastases Secondary to Non-small Cell Lung Cancer—What is the Optimal Treatment Approach?

Cited by 5 publications

References 55 publications

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

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

Organ At Risk (OAR) Data on Clinical Toxicity in The Treatment of Bulky Adrenal Metastases With Stereotactic Ablative Radiotherapy (SABR)

Organ At Risk (OAR) Data on Clinical Toxicity in The Treatment of Bulky Adrenal Metastases With Stereotactic Ablative Radiotherapy (SABR)

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