Stereotactic Body Radiation Therapy for the Treatment of Adrenal Metastases - A Case-Based Radiosurgery Society Practice Guide and Review
- PMID: 40659309
- DOI: 10.1016/j.prro.2025.06.011
Stereotactic Body Radiation Therapy for the Treatment of Adrenal Metastases - A Case-Based Radiosurgery Society Practice Guide and Review
Abstract
Purpose: Adrenal metastases are frequently diagnosed in patients with common solid tumors. Surgical adrenalectomy has historically been used for their management. However, stereotactic body radiation therapy (SBRT) has emerged as a safe and effective alternative. Careful treatment planning is essential, considering multiple factors such as tumor size and location, motion management, dose and fractionation, and proximity to adjacent organs at risk. This case-based practice guide and review provides an overview of SBRT for the management of adrenal tumors, with a particular focus on adrenal metastases.
Methods and materials: Three clinical scenarios were selected to illustrate the use of SBRT in managing adrenal tumors. These include a small right-sided metastasis treated with single-fraction, fiducial-based SBRT, a large left-sided metastasis treated with fractionated SBRT under magnetic resonance imaging guidance, and a case of bilateral metastases, which emphasizes the potential risk of adrenal insufficiency. We also address the limited evidence available regarding the management of primary adrenal gland tumors with SBRT.
Results: SBRT is an effective treatment modality for most adrenal tumors, demonstrating a favorable safety profile. Thoughtful treatment planning and an understanding of potential pitfalls, limitations, and risks are essential to ensure the appropriate use of SBRT.
Conclusions: This case-based guide and review provides a comprehensive overview of SBRT for treating adrenal tumors, specifically metastases. We present and discuss clinical cases and relevant literature, highlighting key considerations specific to adrenal SBRT.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Disclosures Felix Ehret acknowledges funding from the German Cancer Aid and Accuray, and received honoraria and travel support from ZAP Surgical Systems, all outside the submitted work. He is also a member of the Residents’ Executive Committee for the Radiosurgery Society. Tugce Kutuk is member of the Residents’ Executive Committee for the Radiosurgery Society. Karin A. Skalina is member of the Residents’ Executive Committee for the Radiosurgery Society. Simon S. Lo declares that he is a co-principal investigator on a research project funded by the Kuni Foundation and has received research funding in this capacity. He also is serving as the lead academic participating site for the Hutchinson Center under the NIH-funded grant UG1 CA 233328. Moreover, he serves as a member of the Board of Directors for the Radiosurgery Society and as the Medical Director of Distinction in the Stereotactic Radiotherapy Program. In addition, he is a councilor and chair of the Nominating Committee for the Council of the American College of Radiology (ACR), including its CARROS (Committee on Accreditation and Recognition of Radiology Organizations and Services) subcommittee. John L. Gore is a consultant for Astellas Pharmaceuticals and Seagen Pharmaceuticals. Rupesh Kotecha reports grants for his institution from Medtronic, Blue Earth Diagnostics, NovoCure, GT Medical Technologies, AstraZeneca, Exelixis, ViewRay, Brainlab, Cantex Pharmaceuticals, Ion Beam Applications, and Kazia Therapeutics. He reports consulting fees from Kazia Therapeutics, Elekta AB, ViewRay, Castle Biosciences, NovoCure. He has received payments or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Elekta AB, Accuray, NovoCure, ViewRay, Elsevier, BrainLab, Peerview Institute for Medical Education, and Ion Beam Applications. He received travel support from Elekta AB, Accuray, NovoCure, Peerview Institute for Medical Education, Brainlab, and ViewRay. He is member of the data safety monitoring board or advisory board for ViewRay, GT Medical Technologies, Insightec, and Plus Therapeutics. Percy Lee has received consulting fees from Varian, ViewRay, AstraZeneca, Genentech, Johnson & Johnson, Roche, and RTOG Foundation. He has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Varian, ViewRay, AstraZeneca. He received travel support from the Radiosurgery Society. He is member of the data safety monitoring board or advisory board for Genentech, ViewRay, AstraZeneca, and Roche. He holds leadership or fiduciary roles in the Radiosurgery Society and ASTRO. Ben J. Slotman is president of the Radiosurgery Society. Christoph Fürweger has received speaker fees for lectures and presentations from Accuray and ZAP Surgical Systems. He is chair of the physics committee of the Radiosurgery Society. Alexander Muacevic received speaker honoraria from Accuray and is board member of AERO. Shankar Siva has received salary support from the Cancer Council Victoria. He reports grants for his institution from Varian, Bayer Pharmaceuticals, and Merck Sharp Dohme. He has received payments or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca, Varian, Roche, and Telix. He holds leadership or fiduciary roles in the Radiosurgery Society, ASTRO, and the International Association for the Study of Lung Cancer.
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