Background: Isolated adrenal gland metastases are not frequently finding. The aim of the present retrospective study was to estimate clinical and pathological parameters that could be used to predict survival after adrenalectomy.Material and methods: A total of 34 patients with adrenal gland masses suspected to be metastases was included in this study. The group of patients with isolated metastases was19 (56%) and a group of patients with adrenal adenomas -15 (44%).Results: The sample of patients consisted of 18 (53%) men and 16 (47%) women from 40 to 81 years old with a mean (±SD) age of 61.6±10.3 years, presented with adrenal mass suspected to be metastases. Nineteen (56%) of them had demonstrated metastases and 16 (84%) metachronous with median overall survival (OS) 54.6 (range 43-66) months. Median OS in the group with metastases was 22.6 months. Lung carcinoma was the most common primary tumour metastasizing in the adrenal gland -58% of all metastases with a disease-free interval (DFI) of 13 months. It was presented by shorter median survival than the rest primary tumour types (37.8 vs. 96.7months; logrank test, p=0.028). In the multivariate Cox's hazard analysis of the surgical technique was found to be an independent prognostic factor (p=0.047), together with lung carcinoma vs. renal cell carcinoma (p=0.045).Conclusion: Adrenalectomy due to isolated metastases in the adrenal glands showed the median overall survival of 22.6 months. Shorter survival periods were associated with lung carcinoma, DFI<12months, conversion to open surgery, synchronous metastases, but not with age, tumour size or resection status.

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Background: Isolated adrenal metastasis (IAM) from non-small cell lung cancer (NSCLC) is a rare event and the management in such patients remains controversial. Our objective is to evaluate the long-term outcome after resection of IAM in operable NSCLC patients as a part of multimodality treatment. Method: Twelve patients (mean age 58.4 years) underwent adrenalectomy for NSCLC IAM. IAMs were synchronous (7) and metachronous (5), 4 of them were contralateral and 8 ipsilateral. Locoregional pStages I-II were found in 11 patients and pStage IIIA -in 1 patient. One-stage left lower lobectomy and left adrenalectomy through phrenotomy was performed in 1 patient. In 10 cases the curative lung resection was carried out first, followed by adrenalectomy via laparotomy (3), transperitoneal laparoscopy (1) and retroperitoneal endoscopic adrenalectomy (REA) (5). Two years after left lower lobectomy, the metachronous ipsilateral adrenal and contralateral lung metastases were eradicated by REA (first stage) and right polysegmentectomy S7-S10 in 1 patient from this subset. In the last case REA was performed at a first stage, followed by right lower lobectomy. The mean interval between the lung resection and the adrenalectomy was 6 months. All patients were followed up for the mean period of 42 months. The survival was studied by Kaplan-Meier method. Log-Rank test for comparisons was applied. Result: There was no perioperative mortality. The mean overall survival (OS) time is 42.0 months (95% CI 33.8-50.3). One-year and 3-years OS rate is 90.9% and 64.6%, respectively. Six patients are still alive until the last follow-up, four of them are with progression. One of the patients underwent radio-and immunotherapy with good response for local recurrence 20 months after left upper lobectomy. Brain metastases were found in one patient 2 years after initial surgery, which were treated by stereotactic radiosurgery and metastasectomy. Preaortic intraabdominal metastatic lymph node was extirpated in one patient 19 months after left pneumonectomy. One patient underwent irradiation for local recurrence on the bronchial stump 27 months after left pneumonectomy. Mean progression free survival (PFS) time is 25.1 months (95% CI 19.9-30.4).One-year and 2-years PFS rate is 80.0% and 40%. There is no significant difference in mean OS and PSF time between synchronous vs metachronous IAM (p¼0.208; p¼0.364), ipsilateral vs contralateral IAM (p¼0.366; p¼0.156) and laparoscopic vs conventional adrenalectomy (p¼0.163; p¼0.754). Conclusion: Long term survival is possible after resection of IAM in carefully selected NSCLC patients with early locoregional stages without involvement of mediastinal lymph nodes.Background: Lung metastases from a primary extrapulmonary malignancy often represent widespread metastatic disease. There are circumstances, however, where disease may truly be limited. For patients that cannot undergo surgical metastatectomy, SBRT represents a non-invasive option. Herein, we report the results of using lung SBRT to treat limited lung l...