Radioablation of adrenal gland malignomas with interstitial high-dose-rate brachytherapy

Mohnike, Konrad; Neumann, Klaus; Hass, Peter; Seidensticker, Max; Seidensticker, Ricarda; Pech, Maciej; Klose, Silke; Streitparth, Tina; Garlipp, Benjamin; Benckert, Christoph; Wendler, Johann Jakob; Liehr, Uwe-Bernd; Schostak, Martin; Göppner, Daniela; Gademann, G.; Ricke, Jens

doi:10.1007/s00066-017-1120-2

Cited by 18 publications

(7 citation statements)

References 33 publications

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“…Preliminary results suggest good controllability and a good response of the RCC. Analogously, a high local tumour control in HDRBT, using the same techniques, has been found for adrenal-gland malignomas [54] (Figure 6).…”

Section: Local Ablation Proceduressupporting

confidence: 59%

Small renal carcinoma: the “when” and “how” of operation, active surveillance, and ablation

et al. 2018

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Small, locally restricted renal cell carcinoma less than 4 cm in size should ideally be removed operatively by nephron-sparing tumour enucleation (partial kidney resection). In an increasingly elderly population, there is a growing trend toward parallel incidence of renal cell carcinoma and chronic renal insufficiency, with the latter’s associated general comorbidities. Thus, for some patients, the risks of the anaesthesia and operation increase, while the advantage in terms of survival decreases. Transcutaneous radio-frequency ablation under local anaesthesia, transcutaneous afterloading high-dose-rate brachytherapy under local anaesthesia, and percutaneous stereotactic ablative radiotherapy may offer a less invasive alternative therapy. Active surveillance is to be regarded as no more than a controlled bridging up to definitive treatment (operation or ablation), while watchful waiting, on account of the lack of prognostic relevance and the symptomatology of renal cell carcinoma, with its comorbidity-related, clearly reduced life expectancy, does not involve any further diagnostic or therapeutic measures.

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Section: Local Ablation Proceduressupporting

confidence: 59%

Small renal carcinoma: the “when” and “how” of operation, active surveillance, and ablation

et al. 2018

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“…One grade 3 event (bleeding) occurred (3%). Ongoing cortisone substitution after treatment was required in two patients, while one patient required intermittent cortisone substitution for 1-month post-treatment [29]. König et al evaluated 28 patients administered SBRT for adrenal gland metastases.…”

Section: Discussionmentioning

confidence: 99%

Adrenal Gland Irradiation Causes Fatigue Accompanied by Reactive Changes in Cortisol Levels

Huang¹,

Chi²,

Wu³

et al. 2020

Preprint

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Background: Fatigue is a complicated syndrome associated with multiple factors. The development of fatigue after incidental radiotherapy (RT) to the adrenal gland has been observed in clinical practice. This study aimed to investigate the effect of adrenal RT on fatigue and related physiological impacts.Methods: Three patients with inevitable RT to the adrenal gland were enrolled. Serum levels of cortisol, aldosterone, and adrenocorticotropic hormone (ACTH) were measured before, during, and after RT. Fatigue was scored according to the validated fatigue severity scale, and dosimetric parameters were collected. BALB/c mice were surgically explored for the identification of the left adrenal gland. Intra-operative RT was delivered with an electron beam. The swimming endurance test was applied for endurance assessment to represent fatigue. Plasma levels of stress hormones and histopathological features were examined.Results: In the enrolled patients, serum baseline cortisol levels declined after RT. Alterations in levels of morning cortisol and aldosterone showed a similar trend to baseline cortisol, whereas ACTH levels increased, indicating possible compensatory feedback from the hypothalamic-pituitary-adrenal axis. In an experimental mouse model, RT to a unilateral adrenal gland decreased baseline cortisol levels and swimming endurance time. In the histopathological assessment, the irradiated adrenal glands showed characteristic RT injury features in the adrenal cortex.Conclusions: The preliminary clinical observation of fatigue development and characteristic hormone alterations indicated that the adrenal glands could be regarded as an organ at risk from RT adverse effects. This observation was supported by functional and histopathological evidence from an experimental animal model.

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“…bleeding, requiring angiographic embolization) occurred in up to 3%, grade I and II toxicities (e.g. nausea, emesis, unspecified abdominal pain) were reported in up to 29% [ 18 , 25 ]. In the study herein, we did not report any severe adverse event (grade III+) requiring invasive intervention.…”

Section: Discussionmentioning

confidence: 99%

Image-guided interstitial high-dose-rate brachytherapy in the treatment of metastatic esophageal squamous cell carcinoma

Omari

Heinze

Wilck

et al. 2018

jcb

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PurposeTo evaluate the efficacy of computed tomography (CT)- and magnetic resonance imaging (MRI)-guided interstitial high-dose-rate brachytherapy (HDR IBT = IBT) in patients with metastatic esophageal squamous cell carcinoma.Material and methodsEleven patients with 21 unresectable metastases of histologically proven esophageal squamous cell carcinoma were included in this retrospective study. Fourteen visceral and 7 lung metastases were treated with image-guided (CT or open MRI guidance) IBT using a 192Iridium source (single fraction irradiation). Clinical and imaging follow-up were performed every 3 months after treatment. Primary endpoint was local tumor control (LTC) and safety. Furthermore, we analyzed safety, progression-free survival (PFS), and overall survival (OS).ResultsThe median diameter of the target lesions was 2.2 cm (range: 0.7-6.8 cm), treated with a median D100 of 20.1 Gy (range: 10-25 Gy). During a median follow-up of 6.3 months (range: 3-21.8 months), three patients displayed local recurrences, resulting in LTC of 85.7%. Median PFS was 3.4 months and median OS after IBT was 13.7 months. No severe adverse events (grade 3+) requiring hospitalization or invasive intervention were recorded.ConclusionsImage-guided IBT is a safe and effective treatment in patients with metastasized esophageal squamous cell carcinoma.

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Radioablation of adrenal gland malignomas with interstitial high-dose-rate brachytherapy

Abstract: Image-guided HDR-iBT is safe and effective. Treatment- and primary tumor-independent features influenced survival of patients with AGM after HDR-iBR treatment.

Cited by 18 publications

References 33 publications

Small renal carcinoma: the “when” and “how” of operation, active surveillance, and ablation

Small renal carcinoma: the “when” and “how” of operation, active surveillance, and ablation

Adrenal Gland Irradiation Causes Fatigue Accompanied by Reactive Changes in Cortisol Levels

Image-guided interstitial high-dose-rate brachytherapy in the treatment of metastatic esophageal squamous cell carcinoma

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