Stereotactic Radiotherapy for Adrenal Gland Metastases: University of Florence Experience

Casamassima, F.; Livi, Lorenzo; Masciullo, S.; Menichelli, C.; Masi, Laura; Meattini, Icro; Bonucci, I.; Agresti, Benedetta; Simontacchi, Gabriele; Doro, R.

doi:10.1016/j.ijrobp.2010.11.060

Cited by 117 publications

(105 citation statements)

References 22 publications

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“…Radiosurgery (SRS) was employed in only two studies, 20,21 with a median dose of 16-23 Gy (BED = 41.6-75.9 Gy, ˛/ˇ = 10). Most patients had fractionated SBRT with a total dose range of 25-48 Gy delivered in fractions of 3-18 (BED = 22.4-132, ˛/ˇ = 10), with a total number of 5 fractions (4/10, 40%) administered most commonly, followed by 3 fractions (3/10, 30%).…”

Section: Dose and Fractionationmentioning

confidence: 99%

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SBRT: A viable option for treating adrenal gland metastases

Ippolito

D’Angelillo

Fiore

et al. 2015

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tThe management strategy of adrenal metastases depends on different clinical situations.Adrenal metastasectomy in selected patients with isolated adrenal metastases is considered the treatment of choice, showing prolonged survival compared to chemotherapy alone.More recently, Stereotactic Body Radiation Therapy (SBRT) has emerged as an alternative local ablative treatment modality although limited data are available on the use of SBRT in treating adrenal gland metastases. Preliminary results are, however, encouraging, especially in selected patients with oligometastatic disease. We herewith review and discuss the potential role of SBRT as a local ablative treatment modality for adrenal metastases.

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Section: Dose and Fractionationmentioning

confidence: 99%

“…Among all the studies, two grade 2 adrenal insufficiencies were reported, 20,33 but no details were provided regarding the doses received by these patients, nor was it specified whether adrenal function was assessed before treatment. Recently, a clinical case of adrenal insufficiency after SBRT for bilateral adrenal metastases 36 was reported.…”

Section: Toxicitymentioning

confidence: 99%

SBRT: A viable option for treating adrenal gland metastases

Ippolito

D’Angelillo

Fiore

et al. 2015

Reports of Practical Oncology & Radiotherapy

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“…38 CTsimulation-derived 3D datasets contained images in three different breathing phases: non-contrast free-breathing, contrast-enhanced end-expiration, and contrast-enhanced end-inspiration. 40 Simulation and treatment were performed with an empty stomach (nil by mouth [NPO] 3-4 hours) for more reproducible anatomy. 39,41 Baseline diagnostic scans (CT, magnetic resonance imaging [MRI], PET) were fused with the simulation scan for contouring.…”

Section: Simulationmentioning

confidence: 99%

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

Thomsen¹,

Fairchild²

2017

Oncology &Amp; Hematology Review (US)

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B ackground: Five-year overall survival (OS) for patients with stage IV non-small cell lung cancer (NSCLC) is a dismal 1%. However, approximately 7% have limited or solitary metastases, including to the adrenal gland. Radical treatment of these oligometastases (OM) could increase local control and improve OS. Our objective was to critically analyze data describing aggressive treatment of adrenal OM secondary to NSCLC. Methods: A literature search examining English publications describing surgery or radiotherapy (RT) was performed, supplemented by searching reference lists. Case reports of three or fewer patients, and articles from which NSCLC-or adrenal-specific clinical outcomes could not be abstracted, were excluded. Results: Twenty-nine studies met eligibility criteria (521 patients), 26 retrospective. No publications directly compare modalities. Four surgery studies described contemporaneous patients treated with palliative chemotherapy (CH) alone. Reported median OS ranged from 9.5-64 months after adrenalectomy, 8-23 months after RT, and 6-8.5 months after CH. Local failure after surgery was 14%, with response rates after RT 57-75%. Both appear well-tolerated. Conclusions: In patients with an adrenal OM secondary to NSCLC, aggressive treatment should be considered. However, due to the paucity of high quality evidence, it is unclear at present whether this approach alters the natural history of the disease.

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“…Incidence of symptomatic adrenal insuf iciency were reported 4% [2,13]. Casamassima et al and Onishi et al studies, two grade 2 adrenal insuf iencies were reported [11,14].…”

mentioning

confidence: 95%

“…In SBRT implementations for different cancer types determined 30 adrenal metastases, Chawla et al, reported the rates of one-year survival, local control and distant metastasis as 44%, 55% and 13% respectively [10]. In Casamassima et al,'s study on this issue, the rate of two-year local control was found as 90% [11]. Second degree toxicity was seen in none of the above mentioned studies according to the RTOG toxicity classi ication.…”

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confidence: 99%

Adrenal insufficiency in Bilateral Adrenal Metastasis implemented SBRT

Cihan¹

2018

J Radiol Oncol

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Today, there is a considerable increase in localizing adrenal bulks with the bringing radiologic diagnosis methods having high technology into use and improvement in diagnostic tests. Adrenal glands are vital tissues for the organism due to the hormones they secrete. Death is a natural result in the absence of adrenal cortex. Adrenal bulks can be seen with different clinical, laboratory and radiological data. These bulks are often benign and rarely malign. They can be functional or non-functional. Major treatment methods used fort he treatment of adrenal gland primary tumors or metastases are surgery, arterial embolisation, chemical ablation, radiofrequency ablation and radiotherapy [1][2][3][4].Adrenal glands are one of the metastatic ields. In wide autopsy series, adrenal metastasis has been determined between the rates of 13-17% [5]. While unilateral metastasis is common, bilateral metastasis' rate of incidence is between 4-20%. It has been stated that lung (35%), gastric (14%), esophageal (12%) and hepatobiliary (10%) primary carcinomas adrenal metastasis are prevalent most frequently [2]. Curative treatments are tested on patients having cancer with oligo metastasis limited with adrenal gland and primary source is under control because of the expectation of longterm survival, and the surgery is the irst choice. These bulks can be treated with open and laparoscopic surrenalectomy in a curative way. It was reported in studies that overall survival was longer in resection of clinically isolated adrenal metastases when compared with nonsurgical therapy (including RFA, external beam radiotherapy, arterial embolization, radioembolization, chemical ablation, and cryoablation) [1,2,5,7]. Lo et al., found one-year survival as 73% and two-year survival as 40% in their study conducted on 52 patients having curative resection for solitary adrenal metastasis [3]. Tanvetyanon et al., demonstrated 5-year survival rates of 25% following resection of isolated synchronous adrenal metastases and reported 26% after resection of metachronous adrenal metastases in their study conducted on NSCLC patients developing solitary adrenal metastasis [4]. Conducted studies revealed that the rate of complication was 9-20% in patients having adrenalectomy for solitary adrenal metastasis [2][3][4]7].In recent years, the use of radiotherapy, which is a treatment modality as effective as surgical resection, has become prevalent for the management of oligometastases. Today, three different modalities have been tested in the radiotherapy treatment of adrenal gland metastases. In the irst one, total 50 Gy treatment dose with 3D-CRT as daily 2 Gy fraction dose is given [8]. The second one is IMRT implementations for adrenal gland metastases but it isn't thought as suitable according to Practice Guidelines for Neuroendocrine Tumors published by NCCN in 2010. The third radiotherapy modality is stereotactic body radiotherapy (SBRT). SBRT implementations have started to be preferred today since they are completed in a few fractions in addition to tha...

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Stereotactic Radiotherapy for Adrenal Gland Metastases: University of Florence Experience

Cited by 117 publications

References 22 publications

SBRT: A viable option for treating adrenal gland metastases

SBRT: A viable option for treating adrenal gland metastases

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

Adrenal insufficiency in Bilateral Adrenal Metastasis implemented SBRT

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