Stereotactic ablative radiotherapy for adrenal gland metastases: Factors influencing outcomes, patterns of failure, and dosimetric thresholds for toxicity

Chance, William W.; Nguyen, Quynh Nhu; Mehran, Reza J.; Welsh, James W.; Gomez, Daniel R.; Balter, Peter A; Komaki, Ritsuko; Liao, Zhongxing; Chang, Joe Y.

doi:10.1016/j.prro.2016.09.005

Cited by 49 publications

(55 citation statements)

References 29 publications

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“…In their analysis of toxicities, Toesca et al (13) showed that SBRT had no short-term impact on renal function with a mean estimated decline in glomerular filtration rate of only 2.6 ± 8 mL/min/1.73 m 2 compared with baseline. SBRT to adrenal metastases is well tolerated, with nearly all reported side effects being grade 2 or less (12,13).…”

Section: Discussionmentioning

confidence: 99%

“…Adrenal radiation is a well-established noninvasive treatment option for malignant metastases to the adrenal glands. Dosing is determined on the basis of tumor size and location, and ranges between 20 to 70 Gy in 1 to 15 fractions (12)(13)(14). The most common side effects are low grade gastrointestinal-related symptoms (nausea, diarrhea, abdominal pain) and fatigue.…”

Section: Discussionmentioning

confidence: 99%

“…The most common side effects are low grade gastrointestinal-related symptoms (nausea, diarrhea, abdominal pain) and fatigue. Low grade adrenal insufficiency has also been reported and is primarily seen in patients receiving radiation to bilateral adrenal glands (12,13). In their analysis of toxicities, Toesca et al (13) showed that SBRT had no short-term impact on renal function with a mean estimated decline in glomerular filtration rate of only 2.6 ± 8 mL/min/1.73 m 2 compared with baseline.…”

Section: Discussionmentioning

confidence: 99%

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The Novel Use of Stereotactic Radiotherapy for Remnant Adrenal Tissue in Nelson Syndrome

Martirossian

Jacob

Riley

et al. 2020

AACE Clinical Case Reports

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Objective: Recurrent Cushing disease (CD) is a rare complication that occurs in patients who have undergone bilateral adrenalectomy (BLA). We report a case of recurrent CD in a patient with Nelson syndrome and adrenalectomy due to remnant adrenal tissue, and a novel treatment strategy using stereotactic body radiation therapy (SBRT) to the adrenal glands. Methods: We report a case of recurrent CD in a woman with Nelson syndrome and adrenalectomy and describe her clinical course and management. We also include a literature review of CD management and adrenal radiation. Results: The patient had persistent pituitary CD despite pituitary surgery and radiosurgery and underwent BLA. She developed recurrent CD due to a remnant adrenal gland post adrenalectomy. She then underwent SBRT to both adrenal beds to treat the remnant adrenal tissue. Her serum cortisol dropped rapidly after adrenal radiation and she experienced minimal side effects. She has been in remission for over 2 years. Conclusion: This is the first reported case of recurrent CD in a patient post adrenalectomy that was successfully treated with SBRT to the remnant adrenal tissue.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Novel Use of Stereotactic Radiotherapy for Remnant Adrenal Tissue in Nelson Syndrome

Martirossian

Jacob

Riley

et al. 2020

AACE Clinical Case Reports

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“…An internal target volume (ITV) can be created by contouring and combining the gross tumor volumes (GTVs) in each phase of the planning scan as well as on the MRI, if available. Pollom et al 79 82 have published appropriate constraints for 10-fraction HIGRT. The ITV is expanded to the PTV based on the expected set-up variability and intrafraction motion associated with the immobilization device and the reproducibility of respiratory motion management being used.…”

Section: External Beam Rt Techniquementioning

confidence: 99%

“…Individualized dosing based on liver function and patient anatomy (liver-totumor ratio) remains the key to proper HIGRT delivery; tissue heterogeneity and OAR are limiting factors. Our practice has been to treat patients with a total dose up to 82 have published appropriate constraints for 10-fraction HIGRT. If selective underdosing is necessary, then inhomogeneity resulting in a "hotspot" within the PTV may be a desirable compromise.…”

Section: External Beam Rt Techniquementioning

confidence: 99%

The role of external beam radiotherapy in the treatment of hepatocellular cancer

Chino

Stephens

Marin

et al. 2018

Cancer

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Hepatocellular carcinoma (HCC) is increasing in incidence and mortality. Although the prognosis remains poor, long-term survival has improved from 3% in 1970 to an 18% 5-year survival rate today. This is likely because of the introduction of well tolerated, oral antiviral therapies for hepatitis C. Curative options for patients with HCC are often limited by underlying liver dysfunction/cirrhosis and medical comorbidities. Less than one-third of patients are candidates for surgery, which is the current gold standard for cure. Nonsurgical treatments include embolotherapies, percutaneous ablation, and ablative radiation. Technological advances in radiation delivery in the past several decades now allow for safe and effective ablative doses to the liver. Conformal techniques allow for both dose escalation to target volumes and normal tissue sparing. Multiple retrospective and prospective studies have demonstrated that hypofractionated image-guided radiation therapy, used as monotherapy or in combination with other liver-directed therapies, can provide excellent local control that is cost effective. Therefore, as the HCC treatment paradigm continues to evolve, ablative radiation treatment has moved from a palliative treatment to both a "bridge to transplant" and a definitive treatment.

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Fractionated stereotactic radiation therapy for adrenal metastases: contributing to local tumor control with low toxicity

et al. 2018

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Stereotactic ablative radiotherapy for adrenal gland metastases: Factors influencing outcomes, patterns of failure, and dosimetric thresholds for toxicity

Cited by 49 publications

References 29 publications

The Novel Use of Stereotactic Radiotherapy for Remnant Adrenal Tissue in Nelson Syndrome

The Novel Use of Stereotactic Radiotherapy for Remnant Adrenal Tissue in Nelson Syndrome

The role of external beam radiotherapy in the treatment of hepatocellular cancer

Fractionated stereotactic radiation therapy for adrenal metastases: contributing to local tumor control with low toxicity

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