SBRT to adrenal metastases provides high local control with minimal toxicity

Abstract

PurposeThe adrenal glands are a common site of metastases because of their rich blood supply. Previously, adrenal metastases were treated with systemic chemotherapy or, more rarely, with surgical resection or palliative radiation therapy. Stereotactic body radiation therapy (SBRT) has recently emerged as an attractive noninvasive approach to definitively treat these lesions. We present our experience in treating adrenal metastases using SBRT and review the current literature.Methods and materialsThis is a single-institution retrospective review of patients who received SBRT to adrenal metastases originating from various primary malignancies. Patients who were eligible for SBRT included those with limited metastatic disease (≤5 sites) with otherwise controlled metastatic disease and uncontrolled adrenal metastases.ResultsTen patients met the study's inclusion criteria and received SBRT doses of 30 to 48 Gy in 3 to 5 fractions. Acute sequelae of SBRT treatment included 4 patients with grades 1 or 2 nausea, 3 patients with grade 1 fatigue, and 1 with grade 1 diarrhea. The median follow-up was 6 months with a median overall survival of 9.9 months. One patient demonstrated progressive adrenal gland disease 18.8 months after SBRT treatment. Seven patients developed new distant metastases after treatment, with a median progression-free survival of 3.4 months. Three months after SBRT to the adrenal gland, 1 patient developed a gastrointestinal bleed.ConclusionsThese results complement the limited existing body of literature by demonstrating that SBRT provides good control of treated adrenal gland metastasis; however, high-grade late toxicities may occur. More stringent dose constraint limits may prevent associated serious adverse events.

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

“…Limitations to this study were mainly caused by the retrospective nature of this analysis. Patient numbers were rather low, but similar to other studies, as adrenal SBRT is still not offered to many patients [3,21,22,24,36,43,45]. Furthermore, for increasing strength and homogeneity of our study, we only focused our analysis on truly oligometastatic or oligoprogressive patients and excluded all patients who were treated with palliative intent or dose.…”

“…The adrenal glands represent a common site for cancer metastases for a variety of primary tumors, with historic autopsy series reporting an incidence of 9-27% [1]. 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].…”

The Novel Use of Stereotactic Radiotherapy for Remnant Adrenal Tissue in Nelson Syndrome

“…Adrenal radiation is a well-established noninvasive treatment option for malignant metastases to the adrenal glands. Dosing is determined on the basis of tumor size and location, and ranges between 20 to 70 Gy in 1 to 15 fractions (12)(13)(14). The most common side effects are low grade gastrointestinal-related symptoms (nausea, diarrhea, abdominal pain) and fatigue.…”

Metastatic Small-Cell Lung Cancer Presenting as Primary Adrenal Insufficiency

“…The adrenal glands have a rich sinusoidal blood supply providing a conduit for infection and metastasis [5]. Bilateral adrenal metastases at the time of diagnosis are found in 3% of SCLC patients [6], but many other etiologies must be considered.…”