Stereotactic body radiation therapy for adrenal gland metastases: Outcomes and toxicity

Toesca, Diego A.S.; Koong, A.; Eyben, Rie von; Koong, Albert C.; Chang, Daniel T.

doi:10.1016/j.adro.2018.05.006

Cited by 42 publications

(37 citation statements)

References 67 publications

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“…While SBRT is well established and widely applied in the treatment of pulmonary and hepatic oligometastases [17][18][19][20], the literature for adrenal metastases is scarce. Predominantly small and retrospective studies exist which do not primarily focus on oligometastatic or oligoprogressive disease, but also include patients treated with palliative intent [21][22][23][24][25][26][27]. Furthermore, these studies only report limited details on radiotherapy planning and requirement for forced dose restrictions due to the close proximity to radiosensitive organs-at risks (OARs).…”

Section: Introductionmentioning

confidence: 99%

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%

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

et al. 2020

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The most common side effects are low grade gastrointestinal-related symptoms (nausea, diarrhea, abdominal pain) and fatigue. Low grade adrenal insufficiency has also been reported and is primarily seen in patients receiving radiation to bilateral adrenal glands (12,13). In their analysis of toxicities, Toesca et al (13) showed that SBRT had no short-term impact on renal function with a mean estimated decline in glomerular filtration rate of only 2.6 ± 8 mL/min/1.73 m 2 compared with baseline.…”

Section: Discussionmentioning

confidence: 99%

“…Low grade adrenal insufficiency has also been reported and is primarily seen in patients receiving radiation to bilateral adrenal glands (12,13). In their analysis of toxicities, Toesca et al (13) showed that SBRT had no short-term impact on renal function with a mean estimated decline in glomerular filtration rate of only 2.6 ± 8 mL/min/1.73 m 2 compared with baseline. SBRT to adrenal metastases is well tolerated, with nearly all reported side effects being grade 2 or less (12,13).…”

Section: Discussionmentioning

confidence: 99%

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

Martirossian

Jacob

Riley

et al. 2020

AACE Clinical Case Reports

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Objective: Recurrent Cushing disease (CD) is a rare complication that occurs in patients who have undergone bilateral adrenalectomy (BLA). We report a case of recurrent CD in a patient with Nelson syndrome and adrenalectomy due to remnant adrenal tissue, and a novel treatment strategy using stereotactic body radiation therapy (SBRT) to the adrenal glands. Methods: We report a case of recurrent CD in a woman with Nelson syndrome and adrenalectomy and describe her clinical course and management. We also include a literature review of CD management and adrenal radiation. Results: The patient had persistent pituitary CD despite pituitary surgery and radiosurgery and underwent BLA. She developed recurrent CD due to a remnant adrenal gland post adrenalectomy. She then underwent SBRT to both adrenal beds to treat the remnant adrenal tissue. Her serum cortisol dropped rapidly after adrenal radiation and she experienced minimal side effects. She has been in remission for over 2 years. Conclusion: This is the first reported case of recurrent CD in a patient post adrenalectomy that was successfully treated with SBRT to the remnant adrenal tissue.

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“…Stereotactic body radiotherapy (SBRT) has been suggested as an alternative, non-invasive ablative treatment by several authors [3,6,7]. One and three year local rates are reported of more than 80% [8]. Furthermore, SBRT resulted in low rates of toxicity, mostly grade 2 acute toxicity was found [6,7].…”

Section: Introductionmentioning

confidence: 99%

Breath-hold versus mid-ventilation in SBRT of adrenal metastases

Kuijer

Egmond

Kouwenhoven

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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To improve local control in radiotherapy of adrenal metastases precise dose delivery without increasing toxicity is vital. Decreasing the Clinical Target Volume (CTV)-Planning Target Volume (PTV) margins by reducing breathing movement can achieve this. Few data were published concerning the effect of a breath-hold technique. This study investigates the potential of Active Breathing Control (ABC) to limit adrenal breathing movement and reduce CTV-PTV margins. Methods: We compared adrenal gland movement in free-breathing, making use of the Mid-ventilation (MidV) technique, and with ABC. The coordinates of the adrenal glands obtained on ten phases of a free breathing 4D-CT and on several repeat inspiration ABC CT-scans were measured. Separate coordinates, the random margin component and the margin vector norm were computed and compared between the two techniques. Results: We compared the two techniques in 11 patients (21 adrenal glands) and found the largest movement in the Z-direction, with values of 8.7 ± 4.2 mm for MidV and 2.4 ± 1.5 mm for ABC. In 71% of the cases ABC resulted in a smaller margin component than MidV, although non-significant (p ! 0.4). Conclusion: Movement of the adrenal gland is largest in the Z-direction. The mean difference in the margin vector norm between both techniques was small with large variations over the patient group, the clinical effect of these differences is unknown. Applying an individualised motion management strategy could be beneficial. If a peak-to-peak amplitude above 15 mm in the Z-direction is observed in the MidV scan we advise to examine if a breath-hold technique could reduce margins.

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Stereotactic body radiation therapy for adrenal gland metastases: Outcomes and toxicity

Cited by 42 publications

References 67 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

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

Breath-hold versus mid-ventilation in SBRT of adrenal metastases

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