Stereotactic Body Radiation Therapy for Curative Treatment of Adrenal Metastases

Abstract

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.

Robotic Radiosurgery for Adrenal Gland Metastases

“…The applied doses ranged from 15 to 40 Gy using two to 12 fractions. Rudra, et al [17] presented a study with 10 patients with oligometastatic disease. They reported a one-year OS of 90% with a median survival of 17.3 months.…”

The emerging roles of stereotactic ablative radiotherapy for metastatic renal cell carcinoma

“…Similarly, pulmonary metastases are increasingly being treated with SABR, again revealing similar local tumour control rates [12][13][14]. Favourable local control rates are also seen in liver metastases [16][17][18][19][20][21] and adrenal metastases [22][23][24][25][26][27] treated with SABR. Favourable local control rates are also seen in liver metastases [16][17][18][19][20][21] and adrenal metastases [22][23][24][25][26][27] treated with SABR.…”

SBRT: A viable option for treating adrenal gland metastases

“…31 Furthermore, in the study conducted by Rudra et al, 32 which included only patients with oligometastatic disease, the reported 1 year OS was 90% with a median survival of 17.3 months. Finally, in the study by Oshiro et al, 27 patients with metachronous metastasis (with a disease free-interval > 6 months), when compared to the whole study population, showed an improved 2-year OS of 55.6% with median survival of 44.3 months.…”