Evaluation of Stereotactic Body Radiation Therapy in the Management of Adrenal Metastases from Non-Small Cell Lung Cancer

Gamsiz, Hakan; Beyzadeoğlu, Murat; Sager, Omer; Demiral, Selçuk; Dincoglan, Ferrat; Uysal, Bora; Onal, E; Dırıcan, Bahar

doi:10.5301/tj.5000222

Cited by 44 publications

(24 citation statements)

References 42 publications

(32 reference statements)

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“…In this context, microvascular surgical resection, endovascular embolization and radiosurgical treatment may be used for management of AVMs. Stereotactic Radiosurgery (SRS) has been utilized for management of several benign and malign indications with considerable success [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. In the context of AVMs, surgery offers effective management of AVMs in selected patients, however, radiosurgery may be considered when there may be an excessive risk of surgical complications for deep-seated lesions located at eloquent brain regions.…”

Section: Introductionmentioning

confidence: 99%

Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

Dincoglan¹,

Sager

Demiral³

et al. 2019

AJPNMS

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Background: Cerebral arteriovenous malformations (AVMs) are rarely seen congenital vascular anomalies. AVMs may lead to intracranial hemorrages due to disorganized tangle of vessels. Lifetime risk of bleeding from AVMs may be significant given the diagnosis at typically earlier ages of the lifespan, and complications associated with hemorrhage may lead to substantial morbidity or mortality. Management of AVMs aims at eliminating or reducing the risk of subsequent bleeding. In this context, microvascular surgical resection, endovascular embolization and radiosurgical treatment may be used for management of AVMs.Objective: In this study, we assessed the incorporation of Magnetic Resonance Imaging (MRI) in treatment planning for AVM radiosurgery.Â Methods: We identified 25 patients receiving radiosurgery for AVMs at our institution. Radiosurgery target volumes generated by using CT-only based imaging and CT-MR fusion based imaging for each patient were evaluated.Results: Twenty five patients undergoing SRS for AVMs were evaluated for target volume determination in this study. Mean target volume was 4.9 cc (range: 1.3-15.9 cc) on CT-only imaging, 5.7 cc (range: 1.4-16.7 cc) on CT-MR fusion based imaging, and 5.9 cc (range: 1.4-16.9 cc) on consensus decision of all treating physicians with colleague peer review. Target definition based on CT-MR fusion based imaging was identical to the consensus decision of all treating physicians in majority of patients.Conclusions: Treatment planning for AVM radiosurgery may be improved by incorporating CT-MR fusion based imaging, which clearly should be supplemented with additional data from angiography. There is need for additional studies to establish a consensus on optimal target definition by multimodality imaging for SRS of AVMs.

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Section: Introductionmentioning

confidence: 99%

Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

Dincoglan¹,

Sager

Demiral³

et al. 2019

AJPNMS

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“… 3 The safety and tolerability of SBRT in treating adrenal gland metastases have only been reported in small case series; metastases typically originated from a single primary cancer site without a consensus on overall radiation dose or fractionation scheme. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 …”

Section: Introductionmentioning

confidence: 99%

SBRT to adrenal metastases provides high local control with minimal toxicity

Plichta

Camden

Furqan

et al. 2017

Advances in Radiation Oncology

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PurposeThe adrenal glands are a common site of metastases because of their rich blood supply. Previously, adrenal metastases were treated with systemic chemotherapy or, more rarely, with surgical resection or palliative radiation therapy. Stereotactic body radiation therapy (SBRT) has recently emerged as an attractive noninvasive approach to definitively treat these lesions. We present our experience in treating adrenal metastases using SBRT and review the current literature.Methods and materialsThis is a single-institution retrospective review of patients who received SBRT to adrenal metastases originating from various primary malignancies. Patients who were eligible for SBRT included those with limited metastatic disease (≤5 sites) with otherwise controlled metastatic disease and uncontrolled adrenal metastases.ResultsTen patients met the study's inclusion criteria and received SBRT doses of 30 to 48 Gy in 3 to 5 fractions. Acute sequelae of SBRT treatment included 4 patients with grades 1 or 2 nausea, 3 patients with grade 1 fatigue, and 1 with grade 1 diarrhea. The median follow-up was 6 months with a median overall survival of 9.9 months. One patient demonstrated progressive adrenal gland disease 18.8 months after SBRT treatment. Seven patients developed new distant metastases after treatment, with a median progression-free survival of 3.4 months. Three months after SBRT to the adrenal gland, 1 patient developed a gastrointestinal bleed.ConclusionsThese results complement the limited existing body of literature by demonstrating that SBRT provides good control of treated adrenal gland metastasis; however, high-grade late toxicities may occur. More stringent dose constraint limits may prevent associated serious adverse events.

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“…Gamsiz et al described encouraging results of SBRT with ABC for local control and toxicity. 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: 89%

“…An optimised matching technique has yet to be tested in our clinic. Gamsiz et al and Buergy et al only describe that they make use of the kV-CBCT [17,18]. We learned form a personal communication that both authors make use of a mask match (a soft tissue region of interest was defined, the grey values of the CBCT scan and the reference scan were used).…”

Section: Discussionmentioning

confidence: 99%

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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Evaluation of Stereotactic Body Radiation Therapy in the Management of Adrenal Metastases from Non-Small Cell Lung Cancer

Abstract: Stereotactic body radiation therapy offers a safe and efficacious management strategy for adrenal metastases from non-small cell lung cancer by providing excellent local control with negligible treatment related toxicity.

Cited by 44 publications

References 42 publications

Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

SBRT to adrenal metastases provides high local control with minimal toxicity

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

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