Palliative radiotherapy for symptomatic adrenal metastases

Abstract

To evaluate the role of palliative radiotherapy for adrenal metastases, a retrospective review was performed on 16 patients treated between 1972 and 1988 for palliation of symptomatic adrenal metastases. The median patient age was 56 years. In 15 cases lung cancer was the primary site (7 adenocarcinomas, 3 squamous cell carcinomas, 3 large cell carcinomas, and 2 small cell carcinomas) and in 1 case there was an unknown primary (squamous cell carcinoma). Ten of 16 patients were treated with 3000 cGy to opposed anterior and posterior fields (300‐cGy fractions [four patients] and 250‐cGy fractions [six patients]). The remaining six patients were treated with a variety of techniques, with total doses ranging from 2925 cGy to 4500 cGy. The patients were analyzed for response at their first follow‐up visit (2 to 4 weeks after treatment). The overall response rate was 75% (12 of 16 patients). Six patients (38%) had complete pain relief without medication that lasted until death. Two patients had marked pain relief, but still required analgesics. Four patients had marked or moderate pain relief that did not continue through follow‐up. Four patients had minimal to no response. All patients were observed until death, with a median survival time after irradiation of 3 months (range, 0.5 to 11 months). Although the prognosis for patients with adrenal metastases is poor, radiotherapy to symptomatic adrenal metastases can be administered with a high probability of achieving effective palliation.

Adrenalectomy may increase survival of patients with adrenal metastases

“…In those patients with a minimum follow-up of 5 years (n=31), we found at least 1 patient who survived over that period of time, with an average survival of 33.8±4.5 months ( Table III). Given that the highest reported median overall survival in patients treated non-surgically for solitary adrenal metastasis is only 8.5 months (3), and 6.3±2.7 months in our study, and that no long-term survivors were reported in any previous studies (14,21,22) and in our current observation (longest survival is 8 months), we strongly argue that adrenalectomy may alter the natural history of this disease. Long-term survival may be achieved in selected patients.…”

SBRT: A viable option for treating adrenal gland metastases

“…5,6 Historically, radiotherapy has been used with palliative intent with good response rates reported, especially in terms of pain relief (40-80%) defined as a reduction in the use of analgesics. [7][8][9] However, in patients with oligometastatic disease, defined by the presence of one to five metastases, 10 aggressive local therapies may be a reasonable option to prolong progressionfree survival.…”

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

“…67,68 Pain may affect the lower chest, abdomen, back or flank, Review Lung Cancer mimicking hepatic, bone, or chest wall disease. 44,67,69 Pain may be severe enough to require opioids and impact negatively on QOL.…”

“…37 The left adrenal usually extends more cranially than the right; additionally, because the medial border of the left adrenal is closely related to the left celiac ganglion, a left-sided expanding lesion may be more likely to cause pain. 68 Adrenal insufficiency is rare, even when AM are bilateral, as over 90% of the gland must be destroyed before there is functional loss. 44,[68][69][70] An untreated AM will eventually invade the diaphragmatic crus, celiac axis, kidney, posterior stomach, tail of the pancreas and wall of the aorta, and may cause melena or hematemesis; 59 clinically significant hemorrhage into the adrenal is unusual.…”

“…68 Adrenal insufficiency is rare, even when AM are bilateral, as over 90% of the gland must be destroyed before there is functional loss. 44,[68][69][70] An untreated AM will eventually invade the diaphragmatic crus, celiac axis, kidney, posterior stomach, tail of the pancreas and wall of the aorta, and may cause melena or hematemesis; 59 clinically significant hemorrhage into the adrenal is unusual. 33,70 Resection or radiation can therefore be palliative 27,59,68 (Table 6), or be undertaken to try to prevent future symptomatic progression.…”