Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 24;3(4):621-629.
doi: 10.1016/j.adro.2018.05.006. eCollection 2018 Oct-Dec.

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

Diego A S Toesca  1 , Amanda J Koong  1 , Rie von Eyben  1 , Albert C Koong  2 , Daniel T Chang  1
Affiliations

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

Diego A S Toesca et al. Adv Radiat Oncol. .

Abstract

Purpose: This study aimed to report on our institutional experience in the use of stereotactic body radiation therapy (SBRT) for the treatment of adrenal gland metastases. Specifically, we examined the outcomes and toxicity from this treatment modality on adjacent organs at risk.

Methods and materials: Data were retrieved from patients with adrenal metastases who were treated with SBRT between 2008 and 2017. Patients with primary adrenal malignancies were excluded. Toxicities were graded in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Time-to-event rates were calculated from the date of SBRT delivery.

Results: In total, 35 patients with adrenal metastases were identified. Four patients were treated for bilateral disease. The median dose was 40 Gy (range, 20-54 Gy) in 5 fractions (range, 1-6 fractions). The median follow-up time was 37 months (range, 14-451 months) from disease diagnosis and 7 months (range, 1-54 months) from the SBRT start date. With death treated as a competing risk event, the cumulative incidence of local failure was 7.6% at 1 year after SBRT and 19.2% at 3 years. The median overall survival (OS) time was 19 months (95% confidence interval, 8-54 months) and tumor size correlated with survival (P = .0006). Patients with metastases <2.9 cm had a median OS of 54 months compared with 11 months for those with adrenal metastases ≥2.9 cm (P = .01). Incidence of grade 2 toxicity was 17% with no case of grade ≥3 toxicity. SBRT did not impact renal function with a mean estimated decline in glomerular filtration rate of only 2.6 ± 8 mL/min/1.73 m2 compared with baseline. Combined kidneys V5 and combined renal cortex V17.5 did not correlate with a change in estimated glomerular filtration rate (P = .7 and P = .9, respectively).

Conclusions: SBRT offers excellent local control for the treatment of adrenal gland metastases with very low toxicity rates and no significant short-term impact on renal function.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cumulative incidences of (A) local failure and (B) distant failure.
Figure 2
Figure 2
Kaplan-Meier curves of overall survival (A) for entire population and (B) by adrenal metastasis size.
Figure 3
Figure 3
Post-treatment variation of estimated glomerular filtration rate by patient. For 3 patients, post-stereotactic body radiation therapy estimated glomerular filtration rate was not available. Values above zero represent of decline of estimated filtration rate.
Figure 4
Figure 4
Individual patient volumes of (A) combined kidneys V5 (%) and (B) combined renal cortex V17.5 (cm3). eGFR, estimated glomerular filtration rate. NA, not available.
See this image and copyright information in PMC

References

    1. Hellman S. Karnofsky Memorial lecture. Natural history of small breast cancers. J Clin Oncol. 1994;12:2229–2234. - PubMed
    1. Hellman S., Weichselbaum R.R. Oligometastases. J Clin Oncol. 1995;13:8–10. - PubMed
    1. Pastorino U., Buyse M., Friedel G. Long-term results of lung metastasectomy: Prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg. 1997;113:37–49. - PubMed
    1. Wagner J.S., Adson M.A., Van Heerden J.A., Adson M.H., Ilstrup D.M. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg. 1984;199:502–508. - PMC - PubMed
    1. Nordlinger B., Guiguet M., Vaillant J.C. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Française de Chirurgie. Cancer. 1996;77:1254–1262. - PubMed