Cancer Res Treat.  2017 Jan;49(1):20-28. 10.4143/crt.2016.057.

Minimally Invasive Stereotactical Radio-ablation of Adrenal Metastases as an Alternative to Surgery

• Franzese C
• Franceschini D
• Cozzi L
• D’Agostino G
• Comito T
• De Rose F
• Navarria P
• Mancosu P
• Tomatis S
• Fogliata A
• Scorsetti

• KMID: 2367499
• DOI: http://doi.org/10.4143/crt.2016.057

Abstract

PURPOSE
The purpose of this study was to study the clinical outcome for patients with metastases of the adrenal gland treated with stereotactic body radiation therapy.
MATERIALS AND METHODS
Forty-six patients were studied retrospectively. The dose prescription was 40 Gy in four fractions. Dosimetric analysis was performed using the dose volume histograms while clinical outcome was assessed using actuarial analysis with determination of the overall survival (OS) and local control (LC) rates.
RESULTS
The planning objectives were met for all patients. With a median follow-up period of 7.6 months, at the last follow-up 42 patients (91.3%) were alive and four had died because of distant progression. The actuarial mean OS was 28.5±1.6 months, the median was not reached. One-year and 2-year OS were 87.6±6.1%. None of the risk factors was significant in univariate analysis. Actuarial mean LC was 14.6±1.8 months (95% confidence interval [CI], 11.0 to 18.2) and median LC was 14.5±2.0 months (95% CI, 10.5 to 18.5). One-year and 2-year LC were 65.5±11.9% and 40.7±15.8%, respectively. A mild profile of toxicity was observed in the cohort of patients. Forty patients (86.9%) showed no complication (grade 0); two patients reported asthenia, six patients (13.1%) reported either pain, nausea, or vomiting. Of these six patients, five patients (10.9%) were scored as grade 1 toxicity while one patient (2.2%) was scored as grade 2.
CONCLUSION
Stereotactic body radiation therapy treatment provided an adequate clinical response in the management of adrenal gland metastases.

Keyword

Stereotactic body radiotherapy; Adrenal glands; Intensity-modulated radiotherapy

MeSH Terms

Actuarial Analysis
Adrenal Glands
Asthenia
Cohort Studies
Follow-Up Studies
Humans
Nausea
Neoplasm Metastasis*
Prescriptions
Radiosurgery
Radiotherapy, Intensity-Modulated
Retrospective Studies
Risk Factors
Vomiting

Figure

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  Fig. 1. Typical dose distribution (in colowash from 5 to 45 Gy) for axial, sagittal, and coronal views.

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  Fig. 2. Average dose volume histograms (blue line) and interpatient variability at 1 standard deviation (red lines) for target volumes and organs at risk.

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  Fig. 3. Actuarial graphs for overall survival (A) and local control (B).

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