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Liao X, Kishi K, Du K, Komaki R, Mizoe J, Aikawa G, Zheng W, Pan C. Risk factors of local control in adrenal metastases treated by stereotactic body radiation therapy - a systematic review and meta-analysis. Front Oncol 2023; 13:1193574. [PMID: 38045003 PMCID: PMC10691549 DOI: 10.3389/fonc.2023.1193574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose This study is aimed to explore risk factors affect the therapy outcomes of adrenal metastases (AM) for stereotactic body radiation therapy (SBRT) and guide clinical dose selection. Methods and materials PubMed, Embase and Web of Science were searched in September 22, 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Subgroup analysis and meta-regression were used to search for sources of heterogeneity and identify risky outcomes factors. Publication bias test and sensitivity analysis were also conducted. Results Thirty-three studies with full text from 2009 to 2022 about AM with SBRT on 1483 patients were included. Pooled 1- and 2-year local control (LC) and overall survival(OS) were 81.7% (95% confidence interval [CI], 75.6%-86.5%), 62.8% (95% CI, 53.8%-71.8%), 67.4% (95%CI, 61.8%-73.1%) and 46.5% (95%CI, 40.4%-52.6%), respectively. Biological effective dose (BED, α/β=10Gy) and dose per fraction affected 1-year LC (Qm=23.89, 15.10; P<0.0001, 0.0001). In the range of 60-80Gy (BED10), the group of dose per fraction ≥ 9Gy achieved the excellent 1-year LC (< 9Gy: ≥ 9Gy =78%, 91%; χ2 = 10.16, P = 0.001). Tracking technology significantly affected 1- and 2-year OS (Qm = 5.73, 8.75; P = 0.017, 0.003) and high tracking adoption group showed excellent 1- and 2- year OS (78.7% [95%CI, 68.6%- 88.9%]; and 62.9% [95%CI, 53.1%-72.7%]). Conclusion Increasing the dose per fraction appropriately may help control locally AM lesious. Tracking technology might contribute to improve survival of advanced patients with AM. But these results need prospective studies to verify them.
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Affiliation(s)
- Xuehong Liao
- Department of Pathology, Zhongshan Hospital, Xiamen University, Xiamen, China
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kazushi Kishi
- Department of Radiation Oncology, National Disaster Medical Center, National Hospital Organization (NHO), Incorporated Administrative Agency 3256 Tachitawa City, Tokyo, Japan
| | - Kaixin Du
- Department of Radiation Oncology, Xiamen Humanity Hospital Fujian Medical University, Xiamen, China
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ritsuko Komaki
- Department of Radiation Oncology, Emeritus of The University of Texas M.D. Anderson Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Junetsu Mizoe
- Department of Sapporo High Functioning Radiotherapy Center, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Gosuke Aikawa
- Department of Sapporo High Functioning Radiotherapy Center, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Wei Zheng
- Department of Pathology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Chao Pan
- Department of Pathology, Zhongshan Hospital, Xiamen University, Xiamen, China
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2
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Franzese C, Stefanini S, Scorsetti M. Radiation Therapy in the Management of Adrenal Metastases. Semin Radiat Oncol 2023; 33:193-202. [PMID: 36990636 DOI: 10.1016/j.semradonc.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Adrenal glands represent a common site of metastases from several primary tumors, including lung cancer, breast cancer and melanoma. Surgical resection is considered the standard of care, but surgery is not always feasible given the challenges related to anatomical site and/or due to patient and/or disease characteristics. Stereotactic body radiation therapy (SBRT) represents a promising treatment for oligometastases, though the literature on its role for adrenal metastases is still heterogeneous. Herein are summarized the most relevant published studies on the efficacy and safety of SBRT for adrenal gland metastases. The preliminary data suggests that SBRT yields high local control rates and symptom relief with a mild pattern of toxicity. Advanced radiotherapy techniques including IMRT and VMAT, a BED10 > 72 Gy and the use of 4DCT for motion control should be considered for a high quality ablative treatment of adrenal gland metastases.
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3
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Borghesi S, Casamassima F, Aristei C, Grandinetti A, Di Franco R. Stereotactic radiotherapy for adrenal oligometastases. Rep Pract Oncol Radiother 2022; 27:52-56. [PMID: 35402020 PMCID: PMC8989453 DOI: 10.5603/rpor.a2021.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/11/2021] [Indexed: 01/19/2023] Open
Abstract
Approximately 50% of melanomas, 30–40% of lung and breast cancers and 10–20% of renal and gastrointestinal tumors metastasize to the adrenal gland. Metastatic adrenal involvement is diagnosed by computed tomography (CT ) with contrast medium, ultrasound (which does not explore the left adrenal gland well), magnetic resonance imaging (MRI) with contrast medium and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18FDGPET-CT ) which also evaluates lesion uptake. The simulation CT should be performed with contrast medium; an oral bolus of contrast medium is useful, given adrenal gland proximity to the duodenum. The simulation CT may be merged with PET-CT images with 18FDG in order to evaluate uptaking areas. In contouring, the radiologically visible and/or uptaking lesion provides the gross tumor volume (GTV ). Appropriate techniques are needed to overcome target motion. Single fraction stereotactic radiotherapy (SRT ) with median doses of 16–23 Gy is rarely used. More common are doses of 25–48 Gy in 3–10 fractions although 3 or 5 fractions are preferred. Local control at 1 and 2 years ranges from 44 to 100% and from 27 to 100%, respectively. The local control rate is as high as 90%, remaining stable during follow-up when BED10Gy is equal to or greater than 100 Gy. SRT-related toxicity is mild, consisting mainly of gastrointestinal disorders, local pain and fatigue. Adrenal insufficiency is rare.
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Affiliation(s)
- Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | | | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Rossella Di Franco
- Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
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4
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Buergy D, Würschmidt F, Gkika E, Hörner-Rieber J, Knippen S, Gerum S, Balermpas P, Henkenberens C, Voglhuber T, Kornhuber C, Barczyk S, Röper B, Rashid A, Blanck O, Wittig A, Herold HU, Brunner TB, Sweeney RA, Kahl KH, Ciernik FI, Ottinger A, Izaguirre V, Putz F, König L, Hoffmann M, Combs SE, Guckenberger M, Boda-Heggemann J. Stereotactic Body Radiotherapy of adrenal metastases - A dose-finding study. Int J Cancer 2022; 151:412-421. [PMID: 35383919 DOI: 10.1002/ijc.34017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 11/12/2022]
Abstract
Optimal doses for the treatment of adrenal metastases with stereotactic radiotherapy (SBRT) are unknown. We aimed to identify dose-volume cut-points associated with decreased local recurrence rates (LRR). A multicenter database of patients with adrenal metastases of any histology treated with SBRT (biologically effective dose, BED10 ≥ 50Gy, ≤ 12 fractions) was analyzed. Details on dose-volume parameters were required (planning target volume: PTV-D98%, PTV-D50%, PTV-D2%; gross tumor volume: GTV-D50%, GTV-mean). Cut-points for LRR were optimized using the R maxstat package. 196 patients with 218 lesions were included, the largest histopathological subgroup was adenocarcinoma (n = 101). Cut-point optimization resulted in significant cut-points for PTV-D50% (BED10: 73.2Gy; p = 0.003), GTV-D50% (BED10: 74.2Gy; p = 0.006), GTV-mean (BED10: 73.0Gy; p = 0.007), and PTV-D2% (BED10: 78.0Gy; p = 0.02) but not for the PTV-D98% (p = 0.06). Differences in LRR were clinically relevant (LRR ≥ doubled for cut-points that were not achieved). Further dose-escalation was not associated with further improved LRR. PTV-D50%, GTV-D50%, and GTV-mean cut-points were also associated with significantly improved LRR in the adenocarcinoma subgroup. Separate dose optimizations indicated a lower cut-point for the PTV-D50% (BED10: 69.1Gy) in adenocarcinoma lesions, other values were similar (< 2% difference). Associations of cut-points with overall survival (OS) and progression-free survival were not significant but durable freedom from local recurrence was associated with OS in a landmark model (p < 0.001). To achieve a significant improvement of LRR for adrenal SBRT, a moderate escalation of PTV-D50% BED10 > 73.2Gy (adenocarcinoma: 69.1Gy) should be considered. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daniel Buergy
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
| | | | - Eleni Gkika
- Universitätsklinikum Freiburg, Strahlenheilkunde, Freiburg, Deutschland
| | - Juliane Hörner-Rieber
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Deutschland
| | - Stefan Knippen
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Deutschland.,Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Deutschland
| | - Sabine Gerum
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, München, Deutschland.,Klinik für Radiotherapie und Radioonkologie, Paracelsus Universität Salzburg, Landeskrankenhaus, Salzburg, Österreich
| | - Panagiotis Balermpas
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Schweiz
| | - Christoph Henkenberens
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Hannover, Deutschland
| | - Theresa Voglhuber
- Technische Universität München (TUM), Department of Radiation Oncology, Ismaninger Straße 22, Munich
| | - Christine Kornhuber
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Deutschland
| | - Steffen Barczyk
- Zentrum für Strahlentherapie und Radioonkologie, Belegklinik am St. Agnes-Hospital, Bocholt, Deutschland
| | - Barbara Röper
- DIE RADIOLOGIE, MVZ Strahlentherapie Bogenhausen - Harlaching - Neuperlach, München, Deutschland
| | - Ali Rashid
- MediClin Robert Janker Klinik, Klinik für Strahlentherapie und Radioonkologie, Bonn, Deutschland
| | - Oliver Blanck
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Kiel, Deutschland
| | - Andrea Wittig
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Deutschland
| | - Hans-Ulrich Herold
- Cyberknife Centrum Mitteldeutschland GmbH, Institut für Radiochirurgie und Präzisionsbestrahlung, Erfurt, Deutschland
| | - Thomas B Brunner
- Universitätsklinikum Magdeburg, Klinik für Strahlentherapie, Magdeburg, Deutschland
| | - Reinhart A Sweeney
- Leopoldina Krankenhaus Schweinfurt, Klinik für Strahlentherapie, Schweinfurt, Deutschland
| | - Klaus Henning Kahl
- Universitätsklinikum Augsburg, Klinik für Strahlentherapie und Radioonkologie, Augsburg, Deutschland
| | - F Ilja Ciernik
- Städtisches Klinikum Dessau, Klinik für Strahlentherapie und Radioonkologie, Dessau, Deutschland
| | - Annette Ottinger
- Klinikum Darmstadt GmbH, Institut für Radioonkologie und Strahlentherapie, Darmstadt, Deutschland
| | - Victor Izaguirre
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Deutschland
| | - Florian Putz
- Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Deutschland
| | - Laila König
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Deutschland
| | - Michael Hoffmann
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, München, Deutschland
| | - Stephanie E Combs
- Technische Universität München (TUM), Department of Radiation Oncology, Ismaninger Straße 22, Munich.,Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, Neuherberg, Deutschland.,Deutsches Zentrum für Translationale Krebsforschung (DKTK) Partner Site Munich
| | - Matthias Guckenberger
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Schweiz
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
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Adrenal Gland Irradiation Causes Fatigue Accompanied by Reactive Changes in Cortisol Levels. J Clin Med 2022; 11:jcm11051214. [PMID: 35268304 PMCID: PMC8911448 DOI: 10.3390/jcm11051214] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incidental radiotherapy (RT) to the adrenal gland may have systemic effects. This study aimed to investigate the effects of adrenal RT on fatigue. METHODS BALB/c mice were surgically explored to identify the left adrenal gland and delivered intra-operative RT. The swimming endurance test was used for endurance assessment to represent fatigue. Plasma levels of stress hormones and histopathological features were examined. Three patients with inevitable RT to the adrenal gland were enrolled for the preliminary study. Serum levels of cortisol, aldosterone, and adrenocorticotropic hormone (ACTH) were measured before and after RT. Fatigue score by using the fatigue severity scale and RT dosimetric parameters were collected. RESULTS In the experimental mouse model, adrenal RT decreased baseline cortisol from 274.6 ± 37.8 to 193.6 ± 29.4 ng/mL (p = 0.007) and swimming endurance time from 3.7 ± 0.3 to 1.7 ± 0.6 min (p = 0.02). In histopathological assessment, the irradiated adrenal glands showed RT injury features in the adrenal cortex. In the enrolled patients, baseline cortisol significantly declined after RT. There were no significant differences in the levels of morning cortisol, aldosterone, and ACTH before and after RT. CONCLUSIONS The RT dose distributed to the adrenal gland may correlate with unwanted adverse effects, including fatigue and adrenal hormone alterations.
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6
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Sun N, Zhang J, Li B, Li A, Lv M, Zhang C. Favorable response to multimodal treatment in hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus and left adrenal gland metastasis: A case report and literature review. Medicine (Baltimore) 2021; 100:e27987. [PMID: 34889243 PMCID: PMC8663911 DOI: 10.1097/md.0000000000027987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/11/2021] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related deaths and the sixth most commonly diagnosed cancer globally. Interdisciplinary and multimodal treatment strategies are essential for a successful therapy in HCC. Established therapies for HCC treatment include surgical resection, liver transplantation, local ablative therapies, transarterial chemoembolization (TACE), tyrosine kinase inhibitors (TKIs), immunotherapy, and radiotherapy (RT). PATIENT CONCERNS A 52-year-old male patient did an ultrasound scan and found a large mass within the right lobe of the liver and gallstones in December 2018. He had a history of chronic hepatitis C virus infection (30 years) and was treated with sofosbuvir (400 mg, q.d.) for 1 year. The patient never had any symptoms of gallstones. Enhanced abdominal computed tomography of this patient showed a heterogeneous irregular mass with the largest measurement of up to 13.7 × 11.1 cm in size in the right lobe of the liver, meanwhile also had inferior vena cava (IVC) tumor thrombus, right atrial (RA) tumor thrombus, and left adrenal gland metastasis. The laboratory test data revealed that the serum tumor marker α-fetoprotein was 2.63 ng/mL, cancer antigen 19-9 (CA 19-9) was 34.40 U/mL, and protein induced by Vitamin K absence was 391.94 mAU/mL. DIAGNOSIS HCC with IVC tumor thrombus, RA tumor thrombus, and left adrenal gland metastasis, and gallstones. INTERVENTIONS He was hospitalized and received TACE treatment, oral TKIs, intravenous drip programmed cell death-1 (PD-1) inhibitor and RT. OUTCOMES The patient showed a favorable response after consecutive treatment with TACE, TKIs, PD-1 inhibitor, and RT. Until now, the patient has survived 34 months since the diagnosis of the disease. LESSONS Our case suggests that TACE combined with TKIs, PD-1 inhibitor, and RT may be a suitable treatment option for advanced HCC patients with IVC tumor thrombus and/or RA tumor thrombus, and/or adrenal gland metastasis.
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Affiliation(s)
- Ning Sun
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jialin Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Baifeng Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ailin Li
- Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Mutian Lv
- Department of Nuclear Medicine The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Chengshuo Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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7
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Facondo G, Vullo G, Valeriani M, Ascolese AM, De Sanctis V, Osti MF. Stereotactic body radiation therapy (SBRT) for patients with oligometastatic/oligoprogressive adrenal metastases: Outcomes and toxicities profile in a monoinstitutional study. Cancer Treat Res Commun 2021; 29:100481. [PMID: 34700142 DOI: 10.1016/j.ctarc.2021.100481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
AIMS To evaluate survival outcomes and toxicology profiles in oligometastatic/oligoprogressive patients treated with SBRT for adrenal metastases. METHODS We retrospectively analyzed 25 metastatic adrenal lesions in 24 oligometastatic/oligoprogressive patients undergoing ablative Stereotactic Body Radiation Therapy (SBRT) between February 2010 and November 2019 in our department. The primary endpoint was overall survival (OS). Secondary endpoints were local overall response rate (ORR), acute and late toxicities. RESULTS The most common primary tumor was non-small cell lung cancer (54%). Twenty-one patients received chemo or immuno-therapy. The median planning target volume (PTV) was 41.7 cm3. Median SBRT dose was 36 Gy. Median dose per fraction was 15 Gy. Median survival was 35-months with OS outcomes ranging from 6-months (100%), 1-year (87.5%) and 2-years (66.7%). ORR based on RECIST criteria was 66.5%. 12 patients experienced acute toxicities, mostly grade 1-2 (8 patients, 32%). CONCLUSIONS SBRT for oligometastatic/oligoprogressive patients with adrenal metastases showed acceptable survival outcomes and a safe toxicity profile.
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Affiliation(s)
- Giuseppe Facondo
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy.
| | - Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
| | - Anna Maria Ascolese
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
| | - Vitaliana De Sanctis
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
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Reshko LB, Gaskins JT, Silverman CL, Dunlap NE. Stereotactic body radiation therapy (SBRT) of adrenal gland metastases in oligometastatic and oligoprogressive disease. ACTA ACUST UNITED AC 2021; 26:325-340. [PMID: 34277086 PMCID: PMC8281902 DOI: 10.5603/rpor.a2021.0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/23/2021] [Indexed: 12/18/2022]
Abstract
Background Stereotactic body radiation therapy (SBRT) as a form of noninvasive treatment that is becoming increasingly used to manage cancers with adrenal gland metastases. There is a paucity of data on safety and efficacy of this modality. The aim of the study was to evaluate the safety and efficacy of adrenal gland SBRT in oligometastatic and oligoprogressive disease. Materials and methods In this retrospective study, we performed a single-institution analysis of 26 adrenal lesions from 23 patients with oligometastatic or oligoprogressive disease treated from 2013 to 2019 with the goal of achieving durable local control. Palliative cases were excluded. Radiation dosimetry data was collected. Kaplan Meier product estimator and Cox proportional hazards regression analysis were used for statistical analysis. Results The median dose was 36 Gy in 3 fractions (range: 24-50 Gy and 3-6 fractions) with a median biologically effective dose (BED10) of 72 (range: 40-100). 1-year local control rate was 80% and median local control was not achieved due to a low number of failures. 1- and 2-year overall survival rates were 66% and 32%. Toxicity was mild with only one case of grade 2 nausea and no grade 3-5 toxicity. Higher neutrophil to lymphocyte ratio was associated with worse overall survival and a trend toward worse progression-free survival. In addition, worse performance status and lower BED10 were associated with worse survival. No such association could be shown for primary tumor location, histology, size or stage. Conclusion Adrenal SBRT for oligometastatic or oligoprogressive disease is a safe and effective form of treatment.
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Affiliation(s)
- Leonid B Reshko
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, United States of America
| | - Jeremy T Gaskins
- Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, United States of America
| | - Craig L Silverman
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, United States of America
| | - Neal E Dunlap
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, United States of America
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9
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Buergy D, Würschmidt F, Gkika E, Hörner-Rieber J, Knippen S, Gerum S, Balermpas P, Henkenberens C, Voglhuber T, Kornhuber C, Barczyk S, Röper B, Rashid A, Blanck O, Wittig A, Herold HU, Brunner TB, Klement RJ, Kahl KH, Ciernik IF, Ottinger A, Izaguirre V, Putz F, König L, Hoffmann M, Combs SE, Guckenberger M, Boda-Heggemann J. Stereotactic or conformal radiotherapy for adrenal metastases: Patient characteristics and outcomes in a multicenter analysis. Int J Cancer 2021; 149:358-370. [PMID: 33682927 DOI: 10.1002/ijc.33546] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 01/17/2023]
Abstract
To report outcome (freedom from local progression [FFLP], overall survival [OS] and toxicity) after stereotactic, palliative or highly conformal fractionated (>12) radiotherapy (SBRT, Pall-RT, 3DCRT/IMRT) for adrenal metastases in a retrospective multicenter cohort within the framework of the German Society for Radiation Oncology (DEGRO). Adrenal metastases treated with SBRT (≤12 fractions, biologically effective dose [BED10] ≥ 50 Gy), 3DCRT/IMRT (>12 fractions, BED10 ≥ 50 Gy) or Pall-RT (BED10 < 50 Gy) were eligible for this analysis. In addition to unadjusted FFLP (Kaplan-Meier/log-rank), we calculated the competing-risk-adjusted local recurrence rate (CRA-LRR). Three hundred twenty-six patients with 366 metastases were included by 21 centers (median follow-up: 11.7 months). Treatment was SBRT, 3DCRT/IMRT and Pall-RT in 260, 27 and 79 cases, respectively. Most frequent primary tumors were non-small-cell lung cancer (NSCLC; 52.5%), SCLC (16.3%) and melanoma (6.7%). Unadjusted FFLP was higher after SBRT vs Pall-RT (P = .026) while numerical differences in CRA-LRR between groups did not reach statistical significance (1-year CRA-LRR: 13.8%, 17.4% and 27.7%). OS was longer after SBRT vs other groups (P < .05) and increased in patients with locally controlled metastases in a landmark analysis (P < .0001). Toxicity was mostly mild; notably, four cases of adrenal insufficiency occurred, two of which were likely caused by immunotherapy or tumor progression. Radiotherapy for adrenal metastases was associated with a mild toxicity profile in all groups and a favorable 1-year CRA-LRR after SBRT or 3DCRT/IMRT. One-year FFLP was associated with longer OS. Dose-response analyses for the dataset are underway.
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Affiliation(s)
- Daniel Buergy
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
| | | | - Eleni Gkika
- Universitätsklinikum Freiburg, Strahlenheilkunde, Freiburg, Germany
| | - Juliane Hörner-Rieber
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Germany
| | - Stefan Knippen
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Germany.,Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Germany
| | - Sabine Gerum
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, Munich, Germany.,Klinik für Radiotherapie und Radioonkologie, Paracelsus Universität Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Panagiotis Balermpas
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Switzerland
| | - Christoph Henkenberens
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Hannover, Germany
| | - Theresa Voglhuber
- Technische Universität München (TUM), Department of Radiation Oncology, Munich, Germany
| | - Christine Kornhuber
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Germany
| | - Steffen Barczyk
- Zentrum für Strahlentherapie und Radioonkologie, Belegklinik am St. Agnes-Hospital, Bocholt, Germany
| | - Barbara Röper
- Gemeinschaftspraxis für Strahlentherapie, Bogenhausen - Harlaching - Neuperlach, Munich, Germany
| | - Ali Rashid
- MediClin Robert Janker Klinik, Klinik für Strahlentherapie und Radioonkologie, Bonn, Germany
| | - Oliver Blanck
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Kiel, Germany
| | - Andrea Wittig
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Germany
| | - Hans-Ulrich Herold
- Cyberknife Centrum Mitteldeutschland GmbH, Institut für Radiochirurgie und Präzisionsbestrahlung, Erfurt, Germany
| | - Thomas B Brunner
- Universitätsklinikum Magdeburg, Klinik für Strahlentherapie, Magdeburg, Germany
| | - Rainer J Klement
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Switzerland.,Leopoldina Krankenhaus Schweinfurt, Klinik für Strahlentherapie, Schweinfurt, Germany
| | - Klaus Henning Kahl
- Universitätsklinikum Augsburg, Klinik für Strahlentherapie und Radioonkologie, Augsburg, Germany
| | - Ilja F Ciernik
- Städtisches Klinikum Dessau, Klinik für Strahlentherapie und Radioonkologie, Dessau, Germany
| | - Annette Ottinger
- Klinikum Darmstadt GmbH, Institut für Radioonkologie und Strahlentherapie, Darmstadt, Germany
| | - Victor Izaguirre
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Germany
| | - Florian Putz
- Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Germany
| | - Laila König
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Germany
| | - Michael Hoffmann
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Klinikum der Universität München, LMU, Munich, Germany
| | - Stephanie E Combs
- Technische Universität München (TUM), Department of Radiation Oncology, Munich, Germany.,Helmholtz Zentrum München (HMGU), Neuherberg, Germany.,Deutsches Zentrum für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Matthias Guckenberger
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Switzerland
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
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10
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Bürkel F, Jost T, Hecht M, Heinzerling L, Fietkau R, Distel L. Dual mTOR/DNA-PK Inhibitor CC-115 Induces Cell Death in Melanoma Cells and Has Radiosensitizing Potential. Int J Mol Sci 2020; 21:ijms21239321. [PMID: 33297429 PMCID: PMC7730287 DOI: 10.3390/ijms21239321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 12/20/2022] Open
Abstract
CC-115 is a dual inhibitor of the mechanistic target of rapamycin (mTOR) kinase and the DNA-dependent protein kinase (DNA-PK) that is currently being studied in phase I/II clinical trials. DNA-PK is essential for the repair of DNA-double strand breaks (DSB). Radiotherapy is frequently used in the palliative treatment of metastatic melanoma patients and induces DSBs. Melanoma cell lines and healthy-donor skin fibroblast cell lines were treated with CC‑115 and ionizing irradiation (IR). Apoptosis, necrosis, and cell cycle distribution were analyzed. Colony forming assays were conducted to study radiosensitizing effects. Immunofluorescence microscopy was performed to determine the activity of homologous recombination (HR). In most of the malign cell lines, an increasing concentration of CC-115 resulted in increased cell death. Furthermore, strong cytotoxic effects were only observed in malignant cell lines. Regarding clonogenicity, all cell lines displayed decreased survival fractions during combined inhibitor and IR treatment and supra-additive effects of the combination were observable in 5 out of 9 melanoma cell lines. CC-115 showed radiosensitizing potential in 7 out of 9 melanoma cell lines, but not in healthy skin fibroblasts. Based on our data CC-115 treatment could be a promising approach for patients with metastatic melanoma, particularly in the combination with radiotherapy.
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Affiliation(s)
- Felix Bürkel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054 Erlangen, Germany; (F.B.); (T.J.); (M.H.); (R.F.)
| | - Tina Jost
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054 Erlangen, Germany; (F.B.); (T.J.); (M.H.); (R.F.)
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054 Erlangen, Germany; (F.B.); (T.J.); (M.H.); (R.F.)
| | - Lucie Heinzerling
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054 Erlangen, Germany; (F.B.); (T.J.); (M.H.); (R.F.)
| | - Luitpold Distel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054 Erlangen, Germany; (F.B.); (T.J.); (M.H.); (R.F.)
- Correspondence: ; Tel.: +49-9131-85-32312
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11
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Arcidiacono F, Aristei C, Marchionni A, Italiani M, Fulcheri CPL, Saldi S, Casale M, Ingrosso G, Anselmo P, Maranzano E. Stereotactic body radiotherapy for adrenal oligometastasis in lung cancer patients. Br J Radiol 2020; 93:20200645. [PMID: 32822540 DOI: 10.1259/bjr.20200645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To report our experience on stereotactic body radiotherapy (SBRT) in adrenal metastases from lung cancer. METHODS 37 oligometastatic lung cancer patients with 38 adrenal metastases submitted to SBRT were retrospectively analyzed. SBRT was delivered by volumetric modulated arc therapy (VMAT) or helical tomotherapy (HT). Primary study end point was local recurrence-free survival (LR-FS) and secondary end points were distant-progression free survival (d-PFS) and overall survival (OS). RESULTS Median age was 67 years and primary tumor was non-small-cell lung cancer in 27 (73%) and small-cell lung cancer in 10 (27%) patients. Adrenal metastases were in the left side in 66% cases. Median prescribed dose was 30 Gy in 5 fractions for a median biologically equivalent dose (α/β ratio 10 Gy, BED10) of 48 Gy. Most patients (62%) were submitted to SBRT alone, while the others (38%) received chemo-, immune- or target- therapies. Median follow-up was 10.5 months, median OS 16 months and median d-PFS 3 months. 27 (70%) patients obtained a local control with a median LR-FS of 32 months. LR-FS was significantly related to BED10 with a better LC with BED10 ≥72 Gy, 1- and 2 year LR-FS rates were 54.1±11.6% and 45±12.7% vs 100 and 100% for BED ≤59.5 Gy and BED ≥72 Gy, respectively (p = 0.05). There was no severe toxicity. CONCLUSION SBRT was effective and safe in lung cancer adrenal metastases. A dose-response relationship was found between BED10 >72 Gy and better local control. No significant toxicity was registered thanks to the respect of dose constraints and suspension of chemo- and target-therapies. ADVANCES IN KNOWLEDGE SBRT with a BED10 >72 Gy is an effective treatment for adrenal oligometastatic lung cancer patients.
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Affiliation(s)
| | - Cynthia Aristei
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Alessandro Marchionni
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Marco Italiani
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | - Simonetta Saldi
- Radiotherapy Oncology Centre, "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | | | - Gianluca Ingrosso
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
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12
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Zhao X, Zhu X, Zhuang H, Guo X, Song Y, Ju X, Wang P, Yuan Z, Zhang H. Clinical efficacy of Stereotactic Body Radiation Therapy (SBRT) for adrenal gland metastases: A multi-center retrospective study from China. Sci Rep 2020; 10:7836. [PMID: 32398700 PMCID: PMC7217854 DOI: 10.1038/s41598-020-64770-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/24/2020] [Indexed: 11/23/2022] Open
Abstract
To evaluate the efficacy and safety of CyberKnife Stereotactic Body Radiation Therapy (SBRT) in the treatment of adrenal gland metastases (AGM), we designed a large-scale multicenter retrospective study to report the safety and efficacy of SBRT for inoperable AGM. In this study, 75 (61 males, 14 females) patients with 84 AGM and Karnofsky performance score ≥70 were treated by SBRT from October 2006 to January 2017. Of these, the purpose of treatment were controlling all known metastatic sites for 21 patients while 54 for palliation of bulky adrenal metastases. The efficacy and safety of SBRT were evaluated during follow-up. Potential factors predictive of local control (LC) and overall survival (OS) were identified by univariate and multivariate analysis. Median follow-up time was 12.7 months (range 1.8–96.4). The complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) rates were 23.8%, 23.8%, 31.0% and 21.4%, respectively. The 0.5, 1, and 2-year LC rates were 93.6%, 83.8%, and 62.1%, respectively; OS rates on the same follow-up intervals were 93.7%, 62.5%, and 49.6%, respectively, and the corresponding PFS rates were 48.5%, 33.9%, and 16.0%, respectively. The treatment was well tolerated with 2 patients reporting grade-3 diarrhea and fatigue, respectively. Multivariate analysis showed that simultaneous treatment of SBRT for other metastatic lesions, the number of AGM, initiation of systemic therapy, and the maximum diameter of AGM were predictive of LC rates. Moreover, patients with AGM < 5 cm had a superior OS compared with those with AGM ≥ 5 cm (28.0 months vs. 17.6 months, P = 0.032). SBRT is an effective therapeutic option for treatment of AGM with high LC rates with minimal toxicity.
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Affiliation(s)
- Xianzhi Zhao
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Xiaofei Zhu
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, 100191, China
| | - Xueling Guo
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yongchun Song
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Xiaoping Ju
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Ping Wang
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Zhiyong Yuan
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Huojun Zhang
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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13
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Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients. Radiat Oncol 2020; 15:30. [PMID: 32019553 PMCID: PMC7001286 DOI: 10.1186/s13014-020-1480-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
Abstract
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 (BED10) 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 1-and 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 BED10 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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