SBRT: A viable option for treating adrenal gland metastases

Ippolito, Edy; D’Angelillo, Rolando Maria; Fiore, Michele; Molfese, E.; Trodella, Lucio; Ramella, Sara

doi:10.1016/j.rpor.2015.05.009

Cited by 41 publications

(35 citation statements)

References 38 publications

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“…The majority of adrenal metastases are accounted for by primary lung tumors, however breast, kidney, stomach, hepatobiliary carcinoma, and melanoma have also been found to metastasize to the adrenal glands [2,3]. Traditionally, local therapies like surgical resection or radiotherapy were reserved for palliation of symptomatic lesions, with external beam radiotherapy demonstrating good response rates and high rates of pain relief (40-80%) [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

et al. 2020

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Introduction: Local ablative treatment strategies are frequently offered to patients diagnosed with oligometastatic disease. Stereotactic body radiotherapy (SBRT), as ablative treatment option, is well established for lung and liver metastases, whereas for isolated adrenal gland metastases the level of evidence is scarce. Material and methods: This single-institution analysis of oligometastatic or oligoprogressive disease was limited to patients who received SBRT to adrenal metastasis between 2012 and 2019. Patient, tumor, treatment characteristics, and dosimetric parameters were analyzed for evaluation of their effect on survival outcomes. Results: During the period of review 28 patients received ablative SBRT to their adrenal gland metastases. Most common primary tumors were non-small cell lung cancers (46%) with most patients diagnosed with a single adrenal gland metastasis (61%), which occurred after a median time of 14 months. SBRT was delivered to a median biological effective dose at α/β of 10 (BED 10) of 75 Gy (range: 58-151 Gy). Median gross tumor volume (GTV) and median planning target volume (PTV) were 42 and 111 mL, respectively. The homogeneity and conformity indices were 1.17 (range: 1.04-1.64) and 0.5 (range: 0.4.0.99), respectively, with the conformity index being affected by dose restrictions to organs at risk (OARs) in 50% of the patients. Overall response rate based on RECIST criteria was 86% (CR = 29%, PR = 57%) with 2-year local control (LC) of 84.8%, 2-year progression-free survival (PFS) of 26.3%, and 1and 2-year overall survival (OS) of 46.6 and 32.0%, respectively. During follow up, only two local recurrences occurred. A trend for superior LC was seen if BED 10 was ≥75Gy (p = 0.101) or if the PTV was < 100 ml (p = 0.072). SBRT was tolerated well with only mild toxicity. Conclusion: SBRT for adrenal metastases resulted in promising LC with low toxicity. Treatment response appeared to be superior, if SBRT was applied with higher BED. As the close proximity of OARs often limits the application of sufficiently high doses, further dose escalations strategies and techniques should be investigated in future.

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Section: Introductionmentioning

confidence: 99%

“…However, many patients with adrenal gland metastases are considered medically inoperable due to severe comorbidities or the location or the extent of their metastases [16]. For these patients, stereotactic body radiotherapy (SBRT) offers an excellent, noninvasive treatment alternative [4,16].…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

et al. 2020

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“…Over the past several years, there has been increasing interest in the use of SBRT for the treatment of adrenal gland metastases. Review of ten studies including 188 patients reveals that 1-year local control ranged from 44 to 100%, and 1-year overall survival ranged from 39.7 to 90% [62]. Overall survival was mainly influenced by the development of widespread distant metastases.…”

Section: Nonsurgical Treatmentmentioning

confidence: 99%

Adrenal metastases

Samsel¹,

Cichocki²,

Jankowski³

2018

Nowotwory. Journal of Oncology

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The adrenal glands are one of the most prevalent sites for metastases from various malignancies and metastases are indeed the most frequent malignant tumors of the adrenals. The identification of incidental adrenal lesions, of which a high proportion are metastases, have increased since surveillance protocols in cancer treated patients were widely introduced. More sensitive and reliable methods of diagnostic imaging leads to earlier detection of adrenal metastases. If there are no signs and symptoms of disseminated malignant disease, it is essential to differentiate adrenal lesions. CT imaging diagnostics and MRI play the main role in differential diagnosis. Adrenal biopsy is not recommended and is of limited diagnostic value. Appropriate selection of patients with adrenal metastases for curative treatment is a great challenge. Hormonal evaluation should be performed prior to treatment. Adrenalectomy seems to be a reasonable treatment for isolated adrenal metastasis in suitable patients. Minimally invasive laparoscopic adrenalectomy is as effective as the open approach with proven reduction in postoperative pain, morbidity and length of stay. Nonsurgical treatment such as stereotactic body radiation therapy (SBRT), radiotherapy with CyberKnife, percutaneous radiofrequency ablation, percutaneous microwave ablation, radiofrequency plus chemoembolization combined, have been reported with curative and palliative intent and have shown varied results. NOWOTWORY J Oncol 2018; 68, 2: 85-91

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“…Wardak et al, reported that the patient having lung cancer that they implemented SBRT for bilateral adrenal metastases developed adrenal insuf iciency depending on SBRT [6]. Ippolito et al, Reported that adrenal insuf iency may be due to both the tumor and the local treatment [12]. Incidence of symptomatic adrenal insuf iciency were reported 4% [2,13].…”

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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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SBRT: A viable option for treating adrenal gland metastases

Cited by 41 publications

References 38 publications

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

Adrenal metastases

Adrenal insufficiency in Bilateral Adrenal Metastasis implemented SBRT

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