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Lütscher J, Gelpke H, Zehnder A, Mauti L, Padevit C, John H, Batifi N, Zwahlen DR, Förster R, Schröder C. Retrospective Analysis of Efficacy and Toxicity of Stereotactic Body Radiotherapy and Surgical Resection of Adrenal Metastases from Solid Tumors. Cancers (Basel) 2024; 16:2655. [PMID: 39123383 PMCID: PMC11311624 DOI: 10.3390/cancers16152655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND This single-center retrospective study aimed to evaluate the efficacy and toxicity profiles of stereotactic body radiotherapy (SBRT) and surgical resection in patients with adrenal metastases originating from solid tumors. METHODS/MATERIALS Patients with advanced tumor conditions or comorbidities typically received SBRT, whereas those considered physically fit underwent standard surgical treatment. Endpoints included local control (LC), progression free survival (PFS), overall survival (OS), and complication rates (CR). RESULTS 41 patients with 48 adrenal metastases were included, with 27 (65.9%) patients receiving SBRT and 14 (34.1%) patients undergoing adrenalectomy. One- and two-year LC values were 100% for both periods after adrenalectomy, and 70.0% and 52.5% after SBRT (p = 0.001). PFS showed values of 40.2% and 32.1% at one and two years after adrenalectomy and of 10.6% for both periods after SBRT (p = 0.223). OS was 83.3% both one and two years after surgery and 67.0% and 40.2% after SBRT (p = 0.031). There was no statistically significant difference between the two groups regarding acute complications (p = 0.123). CONCLUSION Despite potential confounders, adrenalectomy exhibited statistically significant superior LC and OS compared to SBRT in managing adrenal metastases, while both treatment methods displayed acceptable toxicity profiles. However, patient selection bias must be taken into account when directly comparing the two therapy modalities. Nevertheless, the study provides new and important results for the scientific and medical communities regarding oncological outcomes after SBRT or surgical resection of adrenal metastases.
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Affiliation(s)
- Jamie Lütscher
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Hans Gelpke
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Adrian Zehnder
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Laetitia Mauti
- Department of Medical Oncology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Christian Padevit
- Department of Urology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Hubert John
- Department of Urology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Nidar Batifi
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland
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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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Ehret F, Kaul D, Kufeld M, Endt CV, Budach V, Senger C, Fürweger C, Haidenberger A, Muacevic A. Robotic stereotactic body radiotherapy for the management of adrenal gland metastases: a bi-institutional analysis. J Cancer Res Clin Oncol 2023; 149:1095-1101. [PMID: 35290521 PMCID: PMC9984319 DOI: 10.1007/s00432-022-03943-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Adrenal gland metastases (AGMs) are a common manifestation of metastatic tumor spread, especially in non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In patients with a limited systemic tumor burden, effective treatments for AGMs are needed. Due to varying fractionation schemes and limited reports, short-course treatment results for stereotactic body radiotherapy (SBRT) for AGMs are lacking. This work analyzes the outcomes of short-course SBRT for AGMs. METHODS Patients who underwent robotic SBRT for AGMs with one to five fractions were eligible for analysis. RESULTS In total, data from 55 patients with 72 AGMs from two institutions were analyzed. Most AGMs originated from renal cell carcinoma (38%) and NSCLC (35%). The median follow-up was 16.4 months. The median prescription dose and isodose line were 24 Gy and 70%, respectively. Most patients (85%) received SBRT with just one fraction. The median biologically effective dose assuming an α/β ratio of 10 (BED10) was 80.4 Gy. The local control and progression-free survival after 1 and 2 years were 92.9%, 67.8%, and 46.2%, as well as 24.3%, respectively. Thirteen patients (24%) suffered from grade 1 or 2 toxicities. The BED10 showed a significant impact on LC (p < 0.01). Treatments with a BED10 equal to or above the median were associated with a better LC (p < 0.01). CONCLUSION Robotic SBRT is an efficient and safe treatment modality for AGM. Treatment-associated side effects are sporadic and manageable. Results suggest short-course SBRT to be a preferable and time-saving treatment option for the management of AGMs if an adequate BED10 can be safely applied.
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Affiliation(s)
- Felix Ehret
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany. .,Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany. .,European Radiosurgery Center, 81377, Munich, Germany.
| | - David Kaul
- Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.,Charité CyberKnife Center, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Berlin, 69120, Heidelberg, Germany
| | - Markus Kufeld
- European Radiosurgery Center, 81377, Munich, Germany
| | - Clara Vom Endt
- Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.,Charité CyberKnife Center, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.,Charité CyberKnife Center, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Christoph Fürweger
- European Radiosurgery Center, 81377, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, 50937, Cologne, Germany
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4
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Zhong H, Wang Z, Liu Y, Ke H, Liu P, Lian X, Xu Z. Efficacy and Safety of Ultrasound-Guided Percutaneous Ablation for Adrenal Metastases: A Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36840701 DOI: 10.1002/jum.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of ultrasound-guided percutaneous ablation (US-PA) for adrenal metastases (AMs) using a meta-analysis. METHODS A systematic search of PubMed, Cochrane, Web of Science, and Embase electronic databases was performed to identify studies on US-PA for AM. Seven studies published between January 2000 and August 2022 were analyzed, which resulted in a sample size of 140 patients. Both random effects and common effects meta-analysis models were used to analyze the following efficacy and safety outcomes: the first and secondary technical success rate, 1-year overall survival rates, 1-year local tumor control rate, incidence rate of intraoperative hypertensive crises, and major complications. The subgroup analysis was performed to explore the origin of heterogeneity. RESULTS Among 140 patients from 7 studies included in this meta-analysis: 51 (36.43%) underwent radiofrequency ablation (RFA), and 89 (63.57%) underwent microwave ablation (MWA). Pooled data analysis revealed that the first and secondary technical success rates were 85% (95% confidence interval [CI], 73-96) and 99% (95% CI, 96-100), the 1-year overall survival rate was 83% (95% CI, 71-93), the 1-year local tumor control rate was 83% (95% CI, 75-90), and the incidence rate of intraoperative hypertensive crises was 14% (95% CI, 8-20). The overall rate of major complications was 3.6%. In the subgroup analysis, lower heterogeneity was indicated to be associated with mean tumor size and ablation type. CONCLUSIONS This meta-analysis showed that US-PA can be both effective and safe for AM in terms of overall survival, technical success rate, and local control for AM.
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Affiliation(s)
- Huohu Zhong
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zecheng Wang
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yingchao Liu
- Department of Anesthesiology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Helin Ke
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Piaopiao Liu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xihua Lian
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Zhenhong Xu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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5
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Muacevic A, Adler JR, Gokden N, Menon LP. Incidental, Solitary, and Unilateral Adrenal Metastasis as the Initial Manifestation of Lung Adenocarcinoma. Cureus 2022; 14:e32628. [PMID: 36660511 PMCID: PMC9845493 DOI: 10.7759/cureus.32628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
An adrenal incidentaloma is an adrenal mass ≥ 1 cm in size discovered on imaging performed for indications other than suspected adrenal disease. It has variable etiologies, which can be benign or malignant, including primary or metastatic disease. We present a rare case of metastatic lung adenocarcinoma with isolated unilateral adrenal metastases, presenting as an adrenal incidentaloma in an asymptomatic patient with no known history of malignancy. A 76-year-old man with a past medical history of chronic obstructive pulmonary disease (COPD) and heavy tobacco use was admitted for the evaluation and treatment of pneumonia. He was found to have an incidental 4.6 cm unilateral adrenal mass on his CT chest. He underwent a workup for the mass, including further imaging studies that were indeterminate and a hormonal workup that concluded that the mass was nonfunctional. Due to the patient's comorbidities, it was determined that he was not a surgical candidate. A multidisciplinary team recommended a biopsy, which revealed metastatic lung adenocarcinoma. The primary lung cancer was located using positron emission tomography with 2-deoxy-2-(fluorine-18) fluoro-D-glucose combined with computed tomography (F-FDG-PET/CT). The patient was evaluated by an oncology service and started on chemotherapy. In this case report, we discuss the approach for evaluating adrenal incidentalomas as well as the role the biopsy has in this process based on a literature review. In addition, we draw a comparison between our case and similar cases in the literature while highlighting the differences that make this case unique.
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Durmus IF, Okumus A. Dosimetric comparison of mDCAT and VMAT techniques according to 6MV-FFF and 10MV-FFF energies in patients with single adrenal metastasis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:1023-1032. [PMID: 35848004 DOI: 10.3233/xst-221192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare dosimetric and radiobiological terms of modified dynamic conformal arc therapy (mDCAT) and volumetric modulated arc therapy (VMAT) techniques using different flattening-filter free (FFF) energies in patients with single adrenal metastasis. METHODS In this study, plans were prepared for 10 patients drawing on the mDCAT and VMAT techniques with 6MV-FFF and 10MV-FFF energies. Target volume doses, biological effective doses (BED), quality indices, Monitor Unit (MU), number of segments, beam-on time and critical organ doses were compared in the plans. RESULTS Plans with the significantly lower gradient index (GI) and conformity index (CI) values were obtained with 6MV-FFF energy VMAT planning (p < 0.05). The higher values were obtained for dose to 95% of internal target volume (ITVD95), ITVD95-BED10 with 10MV-FFF energy VMAT planning, whereas lower results were obtained for high dose spillage (HDS%) values (p < 0,05). With 10MV-FFF energy, HDS% values were 21.1% lower in VMAT plans and 5.6% lower in mDCAT plans compared to 6MV-FFF energy. Plans with approximately 50% fewer segments were obtained in mDCAT plans than VMAT plans (p < 0,05). Beam-on time values with mDCAT was 1.84 times lower when 6MV-FFF energies were analyzed, and 2.11 times lower when 10MV-FFF was analyzed (p < 0,05). Additionally, when 6MV-FFF and 10MV-FFF energies were examined, MU values with mDCAT were 2.1 and 2.5 times lower (p < 0,05). In general, the smaller the target volume size, the greater the differences between MU and beam-on time values mDCAT and VMAT. CONCLUSIONS The study results implied that VMAT enabled to offer significantly more conformal SBRT plans with steeper dose fall-off beyond the target volume for single adrenal metastasis than the mDCAT, which attained at the cost of significantly higher MU and beam-on times. Especially with 10MV-FFF energy mDCAT plans, low-dose-bath zones can be reduced, and shorter-term treatments can be implemented with large segments. In adrenal gland SBRT, higher effective doses can be achieved with the right energy and technique, critical organ doses can be reduced, thus increasing the possibility of local control of the tumor with low toxicity.
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Affiliation(s)
- Ismail Faruk Durmus
- Department of Radiation Oncology, Nisantasi University, Istanbul, Turkey
- Department of Radiation Oncology, Yeni Yuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Ayse Okumus
- Department of Radiation Oncology, Nisantasi University, Istanbul, Turkey
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7
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Franzese C, Stefanini S, Massaro M, Comito T, Navarria P, Clerici E, Teriaca A, Franceschini D, Reggiori G, Tomatis S, Lania A, Scorsetti M. Phase II trial of stereotactic body radiation therapy on adrenal gland metastases: evaluation of efficacy and impact on hormonal production. J Cancer Res Clin Oncol 2021; 147:3619-3625. [PMID: 34537907 DOI: 10.1007/s00432-021-03807-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to assess prospectively the efficacy and safety of stereotactic body radiation therapy (SBRT) for adrenal gland metastasis, with a focus on the assessment of the irradiated subjects' endocrinological function. MATERIALS AND METHODS A total of 36 patients were enrolled from 2017 to 2020 in this prospective phase II trial. Patients were treated with Linac-based SBRT, with a dose of 45 Gy in 3 consecutive fractions. Primary end-point was local control (LC) of the treated lesions and secondary end-points included evaluation of acute and late toxicity, progression free survival (PFS), overall survival (OS) and the impact on the hormonal production of adrenal glands. RESULTS With a median follow-up of 9.5 months, LC rates at 1 and 2 years were 94.7% and 88.4%, respectively. Rates of PFS at 1 and 2 years were 50.5% and 29.8%, with a median PFS of 14.7 months. Rates of OS at 1 and 2 years were 62.9% and 44.1%. At univariate analysis, oligorecurrence was associated with better OS compared to oligoprogressive or synchronous metastatic disease. No grade 3 or greater toxicities were registered and only a minority of patients (22.2%) reported mild treatment-related side effects. Hormonal and electrolytes production was assessed before and after treatment, showing only a slight and transient variation within the reference ranges. CONCLUSION SBRT on adrenal metastases has been confirmed to be a feasible and effective treatment. With an excellent disease control and the preservation of the endocrine function, SBRT with ablative dose can be considered a viable alternative to more invasive approaches.
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Affiliation(s)
- Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, Rozzano, 20090, Pieve Emanuele, MI, Italy. .,Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy.
| | - Sara Stefanini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Maria Massaro
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Tiziana Comito
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Elena Clerici
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Ausilia Teriaca
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Giacomo Reggiori
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Stefano Tomatis
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Andrea Lania
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy.,Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, Rozzano, 20090, Pieve Emanuele, MI, Italy.,Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
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8
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Lubomski A, Falhammar H, Torpy DJ, Rushworth RL. The epidemiology of primary and secondary adrenal malignancies and associated adrenal insufficiency in hospitalised patients: an analysis of hospital admission data, NSW, Australia. BMC Endocr Disord 2021; 21:141. [PMID: 34217233 PMCID: PMC8254950 DOI: 10.1186/s12902-021-00787-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/13/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Adrenal insufficiency (AI) causes considerable morbidity but may remain undiagnosed in patients with adrenal malignancy (AM). The epidemiology of AI and adrenal crises (AC) in AM is uncertain. METHODS This was a retrospective study examining hospital admission data from 2006 to 2017. All admissions to all hospitals in NSW, Australia over this period with a principal or comorbid diagnosis of an adrenal malignancy were selected. Data were examined for trends in admissions for AM and associated AI/AC using population data from the corresponding years. RESULTS There were 15,376 hospital admissions with a diagnosis of AM in NSW over the study period, corresponding to 1281 admissions/year. The AM admission rate increased significantly over the study period from 129.9/million to 215.7/million (p < 0.01). An AI diagnosis was recorded in 182 (1.2%) admissions, corresponding to an average of 2.1/million/year. This rate increased significantly over the years of the study from 1.2/million in 2006 to 3.4/million in 2017 (p < 0.01). An AC was identified in 24 (13.2%) admissions with an AI diagnosis. Four patients (16.7%) with an AC died during the hospitalisation. CONCLUSION Admission with a diagnosis of AM has increased over recent years and has been accompanied by an increase in AI diagnoses. While AI is diagnosed in a small proportion of patients with AM, ACs do occur in affected patients.
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Affiliation(s)
- Anna Lubomski
- School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, 141 86, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, North Terrace, Adelaide, Australia
| | - R Louise Rushworth
- School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, Australia.
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9
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Illuminati G, Pasqua R, D'Ermo G, Girolami M, Cerbelli B, D'Amati G, Carboni F, Fiori E. Results of Adrenalectomy for Isolated, Metachronous Metastasis of Breast Cancer: A Retrospective Cohort Study. Front Surg 2021; 8:671424. [PMID: 34179068 PMCID: PMC8219849 DOI: 10.3389/fsurg.2021.671424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aim: Metachronous, isolated adrenal metastases from breast cancer are extremely rare. The aim of this study was to evaluate the results of adrenalectomy as a treatment of this uncommon condition. Methods: Twelve female patients (median age: 68 years) underwent 13 adrenalectomies for isolated, metachronous metastases of breast cancer. Ten resections were performed thorugh open surgery and two were preformed through a laparoscopic approach. As main study endpoints, postoperative mortality, postoperative morbidity and disease-free survival were considered. Median length of follow-up was 40 months. Results: Postoperative mortality was absent. Postoperative morbidity was 17%: one patient presented a postoperative pneumothorax requiring drainage and one patient required re-hospitalization 8 days after contralateral adrenalectomy for electrolyte imbalance. Two patients died of recurrent metastatic disease, 28 and 33 months respectively after adrenalectomy. One patient remained alive with hepatic metastases at 32 months from resection of adrenal recurrence. All in all, disease-free survival at 48 months was 75%. Conclusions: Adrenalectomy for metachronous, isolated metastases of breast cancer can be performed with no postoperative mortality and minimal postoperative morbidity, enabling good long-term disease-free survival.
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Affiliation(s)
- Giulio Illuminati
- Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy
| | - Rocco Pasqua
- Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy
| | - Giuseppe D'Ermo
- Department of Surgery, "Pietro Valdoni", University of Rome "La Sapienza", Rome, Italy
| | - Marco Girolami
- Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy
| | - Bruna Cerbelli
- Department of Medical-Surgical Sciences, Biotechnologies and Pathology, University of Rome "La Sapienza", Rome, Italy
| | - Giulia D'Amati
- Department of Medical-Surgical Sciences, Biotechnologies and Pathology, University of Rome "La Sapienza", Rome, Italy
| | - Fabio Carboni
- Department of Surgery, Regina Elena Cancer Institute, Rome, Italy
| | - Enrico Fiori
- Department of Surgery, "Pietro Valdoni", University of Rome "La Sapienza", Rome, Italy
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10
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Sherlock M, Scarsbrook A, Abbas A, Fraser S, Limumpornpetch P, Dineen R, Stewart PM. Adrenal Incidentaloma. Endocr Rev 2020; 41:bnaa008. [PMID: 32266384 PMCID: PMC7431180 DOI: 10.1210/endrev/bnaa008] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
An adrenal incidentaloma is now established as a common endocrine diagnosis that requires a multidisciplinary approach for effective management. The majority of patients can be reassured and discharged, but a personalized approach based upon image analysis, endocrine workup, and clinical symptoms and signs are required in every case. Adrenocortical carcinoma remains a real concern but is restricted to <2% of all cases. Functional adrenal incidentaloma lesions are commoner (but still probably <10% of total) and the greatest challenge remains the diagnosis and optimum management of autonomous cortisol secretion. Modern-day surgery has improved outcomes and novel radiological and urinary biomarkers will improve early detection and patient stratification in future years to come.
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Affiliation(s)
- Mark Sherlock
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Afroze Abbas
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Sheila Fraser
- Department of Endocrine Surgery, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Padiporn Limumpornpetch
- Faculty of Medicine & Health, University of Leeds, Worsley Building, Clarendon Way, Leeds, UK
| | - Rosemary Dineen
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul M Stewart
- Faculty of Medicine & Health, University of Leeds, Worsley Building, Clarendon Way, Leeds, UK
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11
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Voglhuber T, Kessel KA, Oechsner M, Vogel MME, Gschwend JE, Combs SE. Single-institutional outcome-analysis of low-dose stereotactic body radiation therapy (SBRT) of adrenal gland metastases. BMC Cancer 2020; 20:536. [PMID: 32513136 PMCID: PMC7282163 DOI: 10.1186/s12885-020-07030-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adrenal gland metastases are a common diagnostic finding in various tumor diseases. Due to the increased use of imaging methods, they are diagnosed more frequently, especially in asymptomatic patients. SBRT has emerged as a new, alternative treatment option in the field of radiation oncology. In the past, it was often used for treating inoperable lung, liver, prostate, and brain tumors. Meanwhile, it is also an established keystone in the treatment of oligometastatic diseases. This retrospective study aims to evaluate the effect of low-dose SBRT in patients with adrenal metastases. METHODS We analyzed a group of 31 patients with 34 adrenal gland lesions treated with low-dose SBRT between July 2006 and July 2019. Treatment-planning was performed through contrast-enhanced CT, followed by image-guided stereotactic radiotherapy using cone-beam CT. The applied cumulative median dose was 35 Gy; the median single dose was 7 Gy. We focused on local control (LC), progression-free survival (PFS), overall survival (OS), as well as acute and late toxicity. RESULTS Seven adrenal gland metastases (20.6%) experienced local failure, 80.6% of the patients faced a distant progression. Fourteen patients were still alive. Median follow-up for all patients was 9.8 months and for patients alive 14.4 months. No treatment-related side-effects >grade 2 occurred. Of all, 48.4% suffered from acute gastrointestinal disorders; 32.3% reported acute fatigue, throbbing pain in the renal area, and mild adrenal insufficiency. Altogether, 19.4% of the patients faced late-toxicities, which were as follows: Grade 1: 12.9% gastrointestinal disorders, 3.2% fatigue, Grade 2: 9.7% fatigue, 6.5% headache, 3.2% loss of weight. The 1-year OS and probability of LF were 64 and 25.9%, respectively. CONCLUSION Low-dose SBRT has proven as an effective and safe method with promising outcomes for treating adrenal metastases. There appeared no high-grade toxicities >grade 2, and 79.4% of treated metastases were progression-free. Thus, SBRT should be considered as a therapy option for adrenal metastases as an individual therapeutic concept in the interdisciplinary discussion as an alternative to surgical or systemic treatment.
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Affiliation(s)
- Theresa Voglhuber
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.
| | - Kerstin A Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Heidelberg, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Heidelberg, Germany
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12
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Novel Dose Escalation Approaches for Stereotactic Body Radiotherapy to Adrenal Oligometastases: A Single-Institution Experience. Am J Clin Oncol 2020; 43:107-114. [PMID: 31764023 DOI: 10.1097/coc.0000000000000634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The role of local disease control in the oligometastatic setting is evolving. Stereotactic body radiation therapy (SBRT) is a noninvasive treatment option for oligometastases; however, using ablative radiation doses for adrenal metastases raises concern given the proximity to radiosensitive organs. Novel treatment techniques may allow for selective dose escalation to improve local control (LC) while minimizing dose to nearby critical structures. MATERIALS AND METHODS We retrospectively reviewed patients with adrenal oligometastases treated with SBRT from 2013 to 2018. LC, disease-free survival, and overall survival were estimated using Kaplan-Meier methods. Predictors of outcomes were evaluated by log-rank and Cox proportional hazard analyses. RESULTS We identified 45 adrenal oligometastases in 41 patients treated with SBRT. The median age at treatment was 67 years (range, 40 to 80). The most common primary histologies were non-small cell lung cancer (51%), renal cell carcinoma (24%), and small cell lung cancer (10%). The median prescription dose was 50 Gy (range, 25 to 60 Gy), with 30 (67%) lesions receiving ≥50 Gy and 14 (31%) receiving 60 Gy. In total, 26 (58%) lesions received a simultaneous-integrated boost. Of the 42 treatment simulations, 26 (62%) were supine, 5 (12%) prone, and 11 (26%) in the left lateral decubitus position. At a median follow-up of 10.5 months, there were 3 local failures with a 12-month LC rate of 96%. CONCLUSIONS Adrenal SBRT for oligometastatic disease is a feasible, noninvasive option with excellent LC and minimal toxicity. Lesions in close proximity to radiosensitive organs may benefit from dynamic patient positioning and selective simultaneous-integrated boost techniques to allow for dose escalation, while also limiting toxicity risks.
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13
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Bangash FS. Adrenal Insufficiency Due to Bilateral Adrenal Non-Hodgkin's Lymphoma: A Case Report. Cureus 2020; 12:e7359. [PMID: 32328371 PMCID: PMC7174869 DOI: 10.7759/cureus.7359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Primary adrenal insufficiency is a rare condition due to the impairment of adrenal glands. Previously, tuberculosis damaging adrenal glands was attributed as the main cause for it; whereas, nowadays autoimmune disease is the most common cause of it. However, rarely metastatic malignancy can cause adrenal insufficiency as well. This is a case report of a 72-year-old who presented with a three-month history of being generally unwell. Investigations showed bilateral adrenal masses with a positive short synacthen test (SST) for adrenal insufficiency. Adrenal insufficiency was managed with hydrocortisone and fludrocortisone while the biopsy showed diffuse large B-cell lymphoma (DLBCL). He underwent positron emission tomography/computed tomography (PET/CT) which showed adrenal hypermetabolic disease with retroperitoneal involvement. He was treated as stage 4 non-Hodgkin's lymphoma (NHL) with two cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy on the same admission; he was discharged home with further follow up for chemotherapy sessions. This case is unique as adrenal involvement in DBCL rarely leads to adrenal insufficiency; his symptoms resolved after receiving adrenal insufficiency treatment which further signifies the importance of its diagnosis and management.
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Affiliation(s)
- Fahed S Bangash
- Internal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, GBR
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14
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Naik MM, Nestasie MJ, Gordon MB. Recurrent Invasive Ductal Breast Carcinoma Presenting as Primary Adrenal Insufficiency with Adrenal Crisis. AACE Clin Case Rep 2020; 6:e50-e53. [DOI: 10.4158/accr-2019-0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/12/2019] [Indexed: 11/15/2022] Open
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15
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Tallis PH, Rushworth RL, Torpy DJ, Falhammar H. Adrenal insufficiency due to bilateral adrenal metastases - A systematic review and meta-analysis. Heliyon 2019; 5:e01783. [PMID: 31193734 PMCID: PMC6541881 DOI: 10.1016/j.heliyon.2019.e01783] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/11/2019] [Accepted: 05/17/2019] [Indexed: 12/23/2022] Open
Abstract
Objective Bilateral adrenal metastases may cause adrenal insufficiency (AI) but it is unclear if screening for AI in patients with bilateral adrenal metastases is justified, despite the potential for adrenal crises. Method A search using PubMed/Medline, ScienceDirect and Cochrane Reviews was performed to collect all original research articles and all case reports from the past 50 years that describe AI in bilateral adrenal metastases. Results Twenty studies were included with 6 original research articles, 13 case reports and one case series. The quality was generally poor. The prevalence of AI was 3–8%. Of all cases of AI (n = 25) the mean pooled baseline cortisol was 318 ± 237 nmol/L and stimulated 423 ± 238 nmol/L. Hypotension was present in 69%, hyponatremia in 9% and hyperkalemia in 100%. Lung cancer was the cause in 35%, colorectal 20%, breast cancer 15% and lymphoma 10%. The size of the adrenal metastases was 5.5 ± 2.8 cm (left) and 5.5 ± 3.1 cm (right), respectively. There was no correlation between basal cortisol, stimulated cortisol concentration or ACTH with the size of adrenal metastases. The median time to death was 5.0 months (IQR 0.6–6.5). However, two cases were alive after 12–24 months. Conclusion The prevalence of AI in patients with bilateral adrenal metastases was low. Prognosis was very poor. Due to the low prevalence of AI, screening is likely only indicated in patients with symptoms and signs suggestive of hypocortisolism.
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Affiliation(s)
- Philippa H Tallis
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.,Department of Medicine, Katherine Hospital, Katherine, NT, Australia
| | - R Louise Rushworth
- School of Medicine, Sydney, The University of Notre Dame, Darlinghurst, NSW, Australia
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Henrik Falhammar
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Menzies School of Health Research, Darwin, NT, Australia
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16
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Burjakow K, Fietkau R, Putz F, Achterberg N, Lettmaier S, Knippen S. Fractionated stereotactic radiation therapy for adrenal metastases: contributing to local tumor control with low toxicity. Strahlenther Onkol 2018; 195:236-245. [PMID: 30374590 DOI: 10.1007/s00066-018-1390-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To report on the Erlangen (UK-Er) experience with linear accelerator stereotactic body radiation therapy (LINAC SBRT) for adrenal metastasis from various primary tumors. MATERIALS AND METHODS 33 patients were treated. Primary sites included lung (n = 19), melanoma (n = 8), colorectal (n = 2), hepatocellular (n = 1), esophageal (n = 2), and breast cancer (n = 1). 14 patients were treated palliatively, 19 patients were treated with local curative intent. RADIATION TREATMENT Treatment planning was done based on an exhale, mid-ventilation, and inspiration CT series. Further planning CTs were done to check for the correctness of the breathing pattern. Irradiation was performed using a NOVALIS (Varian, Palo Alto, CA, USA; Brainlab AG, München, Germany) linear accelerator. The isocenter was verified before each treatment session using the BrainLab ExacTrac® (Brainlab AG, München, Germany) system to minimize setup errors. Dose was prescribed to the planning target volume (PTV) surrounding 90% isodose. FOLLOW-UP Depending on their overall performance status and prognosis, patients received clinical check-ups and radiological imaging. Median follow-up was 11 months. STATISTICAL ANALYSIS IBM SPSS v. 24 was used for univariate analysis using Kaplan-Meier curves, nonparametric Kruskal-Wallis test, and the chi-square test for frequency distributions. Toxicity was graded according to NCI CTCAE v4.0. Depending on radiologic imaging, patients were classified as stable, regression, and progression. RESULTS Median survival was 11 months, median PFS was 5 months. Median local failure-free survival was 21 months. Patients who were treated with curative intent showed a better survival curve (p < 0.0001) and PFS (p = 0.004). BED ranged from 42 to 108.8 Gy, median BED was 67.2 Gy. Three BED groups were formed. Overall survival curves differed significantly (p = 0.046), favoring the high-dose group. 21 patients were free from any adverse events or discomfort. In 7 cases, a grade I toxicity was noted.
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Affiliation(s)
- Kim Burjakow
- Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Florian Putz
- Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Nils Achterberg
- Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Sebastian Lettmaier
- Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Stefan Knippen
- Department of Radiation Oncology, Friedrich-Schiller-University Jena, Bachstraße 18, 07743, Jena, Germany.
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17
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Byeon KH, Ha YS, Choi SH, Kim BS, Kim HT, Yoo ES, Kwon TG, Lee JN, Kim TH. Predictive factors for adrenal metastasis in extra-adrenal malignancy patients with solitary adrenal mass. J Surg Oncol 2018; 118:1271-1276. [PMID: 30367684 DOI: 10.1002/jso.25272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/20/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES The adrenal gland is a frequent site for metastasis, and a solitary adrenal mass is often observed during staging workup or imaging follow-up in patients with extra-adrenal malignancy. To create an appropriate management plan, it is essential to distinguish between benign adrenal lesions and metastasis in patients with extra-adrenal cancer having solitary adrenal masses. Therefore, here we evaluated the predictive factors for adrenal metastasis in patients with extra-adrenal malignancy having solitary adrenal mass. MATERIALS AND METHODS From September 2003 to June 2016, we retrospectively reviewed patients with extra-adrenal malignancy having solitary adrenal mass on a cancer staging workup or follow-up study who subsequently underwent adrenalectomy at our institution. All patients underwent preoperative functional studies; those with positive results were excluded from this study. Characteristics of oncology patients with adrenal mass including age, sex, body mass index, smoking, mass location, mass size, hypertension, diabetes mellitus, precontrast Hounsfield unit (HU), and synchronous or metachronous adrenal mass based on the time of the extra-adrenal cancer diagnosis were analyzed. RESULTS Of the total 68 patients with extra-adrenal cancer having solitary adrenal mass, 22 had pathologically confirmed adrenal metastasis. Primary cancers consisted of hepatocellular cell carcinoma (n = 7), renal cell carcinoma (n = 7), lung cancer (n = 4), colon cancer (n = 3), and breast cancer (n = 1). On multivariate analysis, a higher precontrast HU (P = 0.001, odds ratio [OR] = 1.105, 95% confidence interval [CI] = 1.042-1.172), male sex ( P = 0.019, OR = 9.782, 95% CI = 1.462-65.461), and metachronous adrenal mass ( P = 0.007, OR = 11.090, 95% CI = 1.937-63.490) were observed as predictive factors for adrenal metastasis in patients with extra-adrenal cancer having solitary adrenal mass. The cut-off value of precontrast HU to distinguish between metastasis and benign lesions was 36.2 (sensitivity = 81.8%; specificity = 91.3%). CONCLUSION High precontrast HU (> 36), male sex, and metachronous adrenal mass are predictive factors for adrenal metastasis in patients with extra-adrenal malignancy having solitary adrenal mass.
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Affiliation(s)
- Kyeong-Hyeon Byeon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seock Hwan Choi
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Sang Yoo
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Gyun Kwon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Nyung Lee
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae-Hwan Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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18
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Raoofziaee M, Yarmohamadi A, Ahmadnia H. Primary bilateral non-Hodgkin's lymphoma of the adrenal gland. Indian J Urol 2018; 34:300-302. [PMID: 30337789 PMCID: PMC6174724 DOI: 10.4103/iju.iju_113_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary bilateral non-Hodgkin's lymphoma (NHL) of the adrenal gland is very rare. Herein, we report the case of a high-grade lymphoma of both adrenal glands that was found in a 38-year-old patient. The patient was admitted because of an ultrasound which demonstrated large bilateral adrenal masses. The computed tomography scan-guided biopsy of both adrenal glands suggested the diagnosis of bilateral adrenal NHL. Primary bilateral adrenal NHL should be considered as the differential diagnosis of adrenal masses, especially if they are bilateral and well defined with rapid growth in imaging. Early diagnosis and treatment might dramatically affect the clinical outcome.
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Affiliation(s)
- Mohammad Raoofziaee
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aliasghar Yarmohamadi
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Ahmadnia
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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19
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Isolated Synchronous Adrenal Lesions in Patients with Newly Diagnosed Extra-Adrenal Malignancies. Int Surg 2018. [DOI: 10.9738/intsurg-d-18-00019.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background:
This study focused on the etiology of patients with extra-adrenal primary malignancy in addition to isolated synchronous adrenal incidentalomas.
Methods:
Patients who were diagnosed as extra-adrenal primary malignancy and synchronous adrenal incidentalomas were enrolled from a single tertiary medical center from 2004 to 2014. Those with a history of malignancy or any extra-adrenal metastases at the time of diagnosis were excluded. Statistical analysis was performed to determine possible predictors for adrenal metastases.
Results:
The primary malignancies of hepatocellular carcinoma and lung cancer had higher rates of adrenal metastases than colon cancer and renal cell carcinoma. Significant predictors for adrenal metastasis were clinical T stage and adrenal mass diameters. Patients with stage T1/2 primary malignancies were more likely to have benign adrenal tumors than those with stage T3 or T4. The average adrenal mass diameters in the benign and metastatic groups were 2.87 and 4.97 cm, respectively (P = 0.001).
Conclusions:
Nearly 40% of the isolated synchronous adrenal incidentalomas in patients with newly diagnosed extra-adrenal malignancies proved to be metastases. In patients with large adrenal lesions, high mass density on computed tomography scans, or a primary malignancy at a high clinical T stage, the risk of adrenal metastasis was high.
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20
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Plichta K, Camden N, Furqan M, Hejleh TA, Clamon GH, Zhang J, Flynn RT, Bhatia SK, Smith MC, Buatti JM, Allen BG. SBRT to adrenal metastases provides high local control with minimal toxicity. Adv Radiat Oncol 2017; 2:581-587. [PMID: 29204525 PMCID: PMC5707423 DOI: 10.1016/j.adro.2017.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 02/08/2023] Open
Abstract
Purpose The adrenal glands are a common site of metastases because of their rich blood supply. Previously, adrenal metastases were treated with systemic chemotherapy or, more rarely, with surgical resection or palliative radiation therapy. Stereotactic body radiation therapy (SBRT) has recently emerged as an attractive noninvasive approach to definitively treat these lesions. We present our experience in treating adrenal metastases using SBRT and review the current literature. Methods and materials This is a single-institution retrospective review of patients who received SBRT to adrenal metastases originating from various primary malignancies. Patients who were eligible for SBRT included those with limited metastatic disease (≤5 sites) with otherwise controlled metastatic disease and uncontrolled adrenal metastases. Results Ten patients met the study's inclusion criteria and received SBRT doses of 30 to 48 Gy in 3 to 5 fractions. Acute sequelae of SBRT treatment included 4 patients with grades 1 or 2 nausea, 3 patients with grade 1 fatigue, and 1 with grade 1 diarrhea. The median follow-up was 6 months with a median overall survival of 9.9 months. One patient demonstrated progressive adrenal gland disease 18.8 months after SBRT treatment. Seven patients developed new distant metastases after treatment, with a median progression-free survival of 3.4 months. Three months after SBRT to the adrenal gland, 1 patient developed a gastrointestinal bleed. Conclusions These results complement the limited existing body of literature by demonstrating that SBRT provides good control of treated adrenal gland metastasis; however, high-grade late toxicities may occur. More stringent dose constraint limits may prevent associated serious adverse events.
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Affiliation(s)
- Kristin Plichta
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
| | - Nathan Camden
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
| | - Muhammed Furqan
- Department of Internal Medicine, Division of Hematology and Oncology, University of Iowa, Iowa City, Iowa
| | - Taher Abu Hejleh
- Department of Internal Medicine, Division of Hematology and Oncology, University of Iowa, Iowa City, Iowa
| | - Gerald H Clamon
- Department of Internal Medicine, Division of Hematology and Oncology, University of Iowa, Iowa City, Iowa
| | - Jun Zhang
- Department of Internal Medicine, Division of Hematology and Oncology, University of Iowa, Iowa City, Iowa
| | - Ryan T Flynn
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
| | - Sudershan K Bhatia
- Department of Radiation Oncology, Albany Stratton VA Medical Center, Albany, New York
| | - Mark C Smith
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
| | - Bryan G Allen
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
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21
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Roque C, Fonseca R, Bello CT, Vasconcelos C, Galzerano A, Ramos S. Thyrotoxicosis leading to adrenal crises reveals primary bilateral adrenal lymphoma. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170002. [PMID: 28567296 PMCID: PMC5445442 DOI: 10.1530/edm-17-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/06/2017] [Indexed: 11/13/2022] Open
Abstract
Primary adrenal lymphoma is a rare malignancy. It frequently presents bilaterally and with symptoms of adrenal insufficiency. Amiodarone may induce secondary organ dysfunction, and thyrotoxicosis develops in 15% of cases. The symptomatology of both conditions is nonspecific, especially in the elderly, and a high suspicion index is necessary for appropriate diagnosis. A 78-year-old female presented to the emergency department with confusion, nausea and vomiting. She had recently been to the emergency department with urinary tract infection, vomiting and acute hypochloremic hyponatremia. Upon re-evaluation, the leukocyturia persisted and because of TSH 0.01 µU/mL and free-T4 68 (10–18) pmol/L, she was admitted to the Endocrinology ward. Further evaluation supported amiodarone-induced thyroiditis type 2. Sepsis ensued, in the setting of nosocomial pneumonia. Hemodynamic instability, hyponatremia, hypoglycemia and vomiting raised the suspicion of adrenocortical insufficiency. Fluid resuscitation and hydrocortisone led to clinical improvement, and adrenal insufficiency was admitted. The thoracoabdominal tomography suggested an endobronchic primary lesion with hepatic and adrenal secondary deposits (6.6 and 7 cm), but this was confirmed neither on pleural effusion nor on bronchofibroscopic fluid analyses. The adrenals were not accessible for biopsy. Despite high-dose hydrocortisone maintenance, the patient died before definite diagnosis. The autopsy confirmed primary non-Hodgkin lymphoma.
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Affiliation(s)
| | | | | | | | - António Galzerano
- 2Anatomopathology Department, Hospital de Egas Moniz C.H.L.O.-E.P.E, Lisbon Portugal
| | - Sância Ramos
- 2Anatomopathology Department, Hospital de Egas Moniz C.H.L.O.-E.P.E, Lisbon Portugal
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22
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Haidenberger A, Heidorn SC, Kremer N, Muacevic A, Fürweger C. Robotic Radiosurgery for Adrenal Gland Metastases. Cureus 2017; 9:e1120. [PMID: 28451479 PMCID: PMC5406171 DOI: 10.7759/cureus.1120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction The purpose of this study was to investigate the safety and efficacy of CyberKnife (CK) robotic radiosurgery for treatment of adrenal metastases. Methods We performed a retrospective analysis of 23 patients with adrenal metastases who had been treated with CK between October 2006 and December 2015. Fifteen patients received chemotherapy prior to radiosurgery, all patients underwent computer tomography (CT) fluoroscopically guided percutaneous placement of one to three gold fiducials into the adrenal gland. Nineteen patients were selected for single-fraction radiosurgery with a median dose of 22 Gy, four patients were treated in three fractions with a median dose of 13.5 Gy. Results Median follow-up time was 23.6 months. Four patients (17%) experienced local relapse during the evaluation period with a mean time of 19 months to tumor progression. The actuarial local tumor control rate was 95% after one year and 81% after two years. Three of the four patients with local recurrence were retreated with CK radiosurgery. Dynamic tumor tracking enabled accurate treatment with correlation errors less than 2 mm, despite extensive respiration-induced target motion up to 22 mm. Apart from nausea directly after treatment in five patients, we observed no early or late treatment-related side effects. Conclusions Single fraction robotic radiosurgery for adrenal gland metastases is a safe and effective treatment option for patients who are not eligible for surgical resection.
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Desai A, Rai H, Haas J, Witten M, Blacksburg S, Schneider JG. A Retrospective Review of CyberKnife Stereotactic Body Radiotherapy for Adrenal Tumors (Primary and Metastatic): Winthrop University Hospital Experience. Front Oncol 2015; 5:185. [PMID: 26347852 PMCID: PMC4538288 DOI: 10.3389/fonc.2015.00185] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022] Open
Abstract
The adrenal gland is a common site of cancer metastasis. Surgery remains a mainstay of treatment for solitary adrenal metastasis. For patients who cannot undergo surgery, radiation is an alternative option. Stereotactic body radiotherapy (SBRT) is an ablative treatment option allowing larger doses to be delivered over a shorter period of time. In this study, we report on our experience with the use of SBRT to treat adrenal metastases using CyberKnife technology. We retrospectively reviewed the Winthrop University radiation oncology data base to identify 14 patients for whom SBRT was administered to treat malignant adrenal disease. Of the factors examined, the biological equivalent dose (BED) of radiation delivered was found to be the most important predictor of local adrenal tumor control. We conclude that CyberKnife-based SBRT is a safe, non-invasive modality that has broadened the therapeutic options for the treatment of isolated adrenal metastases.
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Affiliation(s)
- Amishi Desai
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Hema Rai
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Jonathan Haas
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Matthew Witten
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Seth Blacksburg
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Jeffrey G Schneider
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
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Carvalho F, Louro F, Zakout R. Adrenal Insufficiency in Metastatic Lung Cancer. World J Oncol 2015; 6:375-377. [PMID: 28983332 PMCID: PMC5624663 DOI: 10.14740/wjon890w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 11/16/2022] Open
Abstract
We report a case of adrenal insufficiency in patient with lung cancer. Although adrenal metastases are common in cancer patients, adrenal insufficiency is a rare occurrence. Diagnosis and treatment of adrenal insufficiency will improve the physical status and the quality of life in those patients.
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Affiliation(s)
- Filipe Carvalho
- Physical Medicine and Rehabilitation Department, Hospital Prof. Doutor Fernando Fonseca, E.P.E., Portugal
| | - Fernanda Louro
- Department of Medicine I, Hospital Prof. Doutor Fernando Fonseca, E.P.E., Portugal
| | - Raed Zakout
- Department of Medicine I, Hospital Prof. Doutor Fernando Fonseca, E.P.E., Portugal
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Trinanjan Basu TB, Kataria T, Abhishek A, Gupta D, Goyal S, Bisht S, Payaliappan K, Subhramani V. Cyberknife fractionated radiotherapy for adrenal metastases: Preliminary report from a multispecialty Indian cancer care center. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0301.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Modified anatomical retroperitoneoscopic adrenalectomy for adrenal metastatic tumor: technique and survival analysis. Surg Endosc 2012; 27:992-9. [PMID: 23239289 DOI: 10.1007/s00464-012-2553-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/14/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND In a previous experience, anatomical retroperitoneoscopic adrenalectomy (ARA) was proven safe, effective, and technically efficient for surgical adrenal diseases. However, laparoscopic adrenalectomy for adrenal metastasis is controversial. We evaluated the safety, effectiveness, and efficiency of modified ARA technique for adrenal metastasis and predicted survival factors. METHODS From 2000 to 2010, a consecutive series of 75 patients with adrenal metastases underwent 78 ARAs (three bilateral ARAs). Three modifications and one key procedure were specified in this study. Medical records and follow-up data were retrospectively studied. Then, the surgery data of ARA were compared with those of other approaches to evaluate its safety, effectiveness, and efficiency. Additionally, univariate and multivariate analyses were used to predict the risk factors for survival. RESULTS The most common primary tumor was renal cell carcinoma (RCC, n = 26), followed by non-small-cell lung carcinoma (NSCLC, n = 23), and hepatocellular carcinoma (HCC, n = 12). A total of 76 successful ARAs and two conversions to open surgery were performed, with a median operation time of 53 (range, 40-250) min and median estimated blood loss of 25 (range, 10-700) mL. The local recurrence rate was 5.3 %, and the median survival was 24 months. These data were comparable with or even better than other approaches in previous studies. The independent prognostic factors of survival were body mass index (BMI, p < 0.001), tumor type (p < 0.001), tumor size (≥ 4 cm vs. <4 cm, p = 0.017), and margin status (negative vs. positive, p = 0.011). CONCLUSIONS ARA is a safe and effective approach for the management of adrenal metastasis in selected patients. BMI, tumor type, tumor size, and margin status may independently predict survival.
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Zerrweck C, Caiazzo R, Clerquin B, Donatini G, Lamblin A, Khatib ZE, Arnalsteen L, Carnaille B, Pattou F. Renal Origin and Size are Independent Predictors of Survival After Surgery for Adrenal Metastasis. Ann Surg Oncol 2012; 19:3621-6. [DOI: 10.1245/s10434-012-2464-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Indexed: 11/18/2022]
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de la Quintana Basarrate A, Martínez Fernández G, Arana González A, Prieto M, Alvarez I, Martínez Indart L, García González JM, Perdigo Bilbao LF, Colina Alonso A. [Surgical treatment of adrenal gland metastases: results in a series of 35 patients]. Cir Esp 2012; 90:634-40. [PMID: 22726448 DOI: 10.1016/j.ciresp.2012.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 04/24/2012] [Accepted: 04/26/2012] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The objectives of this study are to present the results of adrenalectomies due to metastasis, and to analyse the prognostic factors that may help to predict long-term survival in this patient group. PATIENTS AND METHODS A retrospective study was conducted on 35 patients who underwent adrenalectomy for metastases in the Hospital de Cruces from 1996 to January 2010. The survival analysis was performed using the Kaplan and Meier method. RESULTS Non-small cell lung cancer (NSCLC) was the most frequent primary tumour, with 18 cases. In 15 patients the diagnosis of adrenal metastasis was synchronous with the primary tumour, and in 20 cases it was metachronous. Only 7 patients survived without disease for 12, 22, 26, 58, 60, 65 and 120 months after the adrenalectomy. The disease free survival at 5 years was 16% in the whole series, and 27% in the NSCLC sub-group. None of the prognostic factors evaluated (size greater than 4.5 cm, cell type, differentiation grade, chemotherapy, surgical technique, disease free interval) was statistically significant in the overall survival, either in the general series or in the sub-group of patients with NSCLC. However, in the general series with tumour recurrence, the difference in survival between metachronous and synchronous metastasis was statistically significant (P=.05), in favour of the former. CONCLUSIONS Adrenalectomy improves the expected survival particularly in patients with NSCLC. Patients with metachronous metastases do not have a higher rate of disease free survival at 5 years than those with synchronous metastases, although they do have a longer survival with the disease. When there is tumour recurrence, it is usually early.
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Torok J, Wegner RE, Burton SA, Heron DE. Stereotactic body radiation therapy for adrenal metastases: a retrospective review of a noninvasive therapeutic strategy. Future Oncol 2011; 7:145-51. [PMID: 21174545 DOI: 10.2217/fon.10.165] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS The role of radiation therapy in the treatment of adrenal metastases has traditionally been a palliative one, achieving excellent pain control with very limited toxicity. Recent studies have focused on the potential role of stereotactic body radiation therapy (SBRT) with curative intent in limited metastatic disease, its potential to reduce tumor burden and to prevent symptomatic progression. This study reports the single-institution outcomes of SBRT utilizing both single fraction and hypofractionated regimens in the treatment of adrenal metastases. METHODS A total of seven patients with nine adrenal metastases treated with SBRT at the University of Pittsburgh Cancer Institute were retrospectively studied. The primary malignancies consisted of non-small-cell lung cancer (n = 4), small-cell lung cancer (n = 1) and hepatocellular carcinoma (n = 2). RESULTS Five lesions were treated in a single fraction to a median prescription dose of 16 Gy (range: 10-22 Gy) to the 80% isodose line. The remaining four lesions were treated over three fractions to a median prescription dose of 27 Gy (range: 24-36 Gy), with a median prescription isodose line of 94% (range: 80-94%). Median follow-up from the primary diagnosis was 38 months (range: 7-88 months) and from SBRT was 14 months (range: 1-60 months). Follow-up imaging for six patients, and eight metastatic lesions, revealed one complete response, two partial responses and five stable lesions. Five of the lesions eventually failed locally, with a median time to failure of 12 months and actuarial local control of 63% at 1 year. The median overall survival was 8 months from SBRT. CONCLUSION SBRT can be safely delivered in single fraction, or hypofractionated, regimens for the treatment of adrenal metastases.
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Affiliation(s)
- Jordan Torok
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA
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Casamassima F, Livi L, Masciullo S, Menichelli C, Masi L, Meattini I, Bonucci I, Agresti B, Simontacchi G, Doro R. Stereotactic radiotherapy for adrenal gland metastases: university of Florence experience. Int J Radiat Oncol Biol Phys 2011; 82:919-23. [PMID: 21300473 DOI: 10.1016/j.ijrobp.2010.11.060] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/29/2010] [Accepted: 11/02/2010] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate a retrospective single-institution outcome after hypofractionated stereotactic body radiotherapy (SBRT) for adrenal metastases. METHODS AND MATERIALS Between February 2002 and December 2009, we treated 48 patients with SBRT for adrenal metastases. The median age of the patient population was 62.7 years (range, 43-77 years). In the majority of patients, the prescription dose was 36 Gy in 3 fractions (70% isodose, 17.14 Gy per fraction at the isocenter). Eight patients were treated with single-fraction stereotactic radiosurgery and forty patients with multi-fraction stereotactic radiotherapy. RESULTS Overall, the series of patients was followed up for a median of 16.2 months (range, 3-63 months). At the time of analysis, 20 patients were alive and 28 patients were dead. The 1- and 2-year actuarial overall survival rates were 39.7% and 14.5%, respectively. We recorded 48 distant failures and 2 local failures, with a median interval to local failure of 4.9 months. The actuarial 1-year disease control rate was 9%; the actuarial 1- and 2-year local control rate was 90%. CONCLUSION Our retrospective study indicated that SBRT for the treatment of adrenal metastases represents a safe and effective option with a control rate of 90% at 2 years.
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Affiliation(s)
- Franco Casamassima
- Clinical Radiobiological Institute, University of Florence, Florence, Italy.
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31
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Abstract
ABSTRACT
Adrenal lymphoma is a rare diagnosis in subject presenting with bilateral adrenal masses. Adrenal insufficiency is a common complication of this disease. Most cases of primary adrenal lymphoma (PAL) present with adrenal insufficiency and huge bilateral adrenal masses. These are very aggressive tumors with poor prognosis. We, hereby, report two subjects of adrenal lymphoma presenting with bilateral adrenal masses. First case is a 50 years old male presented with features of adrenal insufficiency like anorexia, weight loss, nausea, vomiting, and generalized hyperpigmentation. Routine investigations revealed hyponatremia, normal serum K; serum lactate dehydrogenase was moderately elevated. Primary adrenal insufficiency was confirmed by low basal and cosyntrophin stimulated cortisol. CT abdomen revealed huge bilateral heterogeneous enlargement of adrenal glands. Lymphoma was confirmed by histopathology and immunohistochemistry, diagnosis of PAL was made after further staging. He was treated with Rituximab-CHOP regimen. Second case, 50 years old lady presented with fever, anorexia, weight loss. She had generalized lymphadenopathy. On imaging found to have bilateral adrenal mass, and histopathology from lymph node, breast mass and adrenal mass was suggestive of non-Hodgkin's lymphoma.
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33
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Taylor RW. Adrenal Insufficiency in the Critically Ill Patient. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50062-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Casteràs Román A, Páramo Fernández MC, Hervás Abad E, Fajar Rodríguez L, Mantiñán Gil B, García-Mayor RV. [Non-autoimmune adrenal failure: Addison's disease due to infiltration of adrenal glands of non-Hodgkin's lymphoma]. Rev Clin Esp 2007; 207:591-3. [PMID: 18021660 DOI: 10.1157/13111590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Although metastases to the adrenals are common in humans, they have not been thoroughly studied in animals. The purpose of this retrospective study was to document the types of malignant tumors that metastasize to canine, feline, equine, and bovine adrenals, and the rate at which they do so. The average rate of adrenal involvement in metastatic cancer was 112/534 (21.0%) in dogs, 12/81 (14.8%) in cats, 18/67 (26.9%) in horses, and 5/16 (31.3%) in cattle. In dogs, 26 different tumor types metastasized to the adrenals. Pulmonary, mammary, prostatic, gastric, and pancreatic carcinomas, and melanoma had the highest rates of metastasis to the adrenal glands in dogs. Hemangiosarcoma and melanoma had high rates of adrenal involvement in horses. In cats and cattle, relevant data were only available for lymphoma. Adrenal metastases usually occurred in the late stages of the disease. One dog had developed Addison's disease (hypoadrenocorticism) secondary to lymphoma. Metastatic lesions represented 126/472 (26.7%) of canine, 12/20 (60.0%) of feline, 21/80 (26.3%) of equine, and 5/9 (55.5%) of bovine adrenal neoplasms. This study shows that adrenal glands should be thoroughly examined during both clinical work-up and postmortems when disseminated neoplasia is suspected.
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Affiliation(s)
- P Labelle
- Department of Pathology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
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37
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Blaikley JF, Atkinson P, Almond MK. Cutaneous T-cell lymphoma with adrenal insufficiency. J R Soc Med 2003; 96:503-4. [PMID: 14519731 PMCID: PMC544634 DOI: 10.1258/jrsm.96.10.503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- J F Blaikley
- Southend Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, UK.
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38
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Blaikley JF, Atkinson P, Almond MK. Cutaneous T-Cell Lymphoma with Adrenal Insufficiency. Med Chir Trans 2003. [DOI: 10.1177/014107680309601011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J F Blaikley
- Southend Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, UK
| | - P Atkinson
- Southend Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, UK
| | - M K Almond
- Southend Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, UK
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39
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Adrenal Insufficiency. Surg Oncol 2003. [DOI: 10.1007/0-387-21701-0_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE Adrenal metastases are frequently encountered during autopsy but uncommonly present clinically. The aim of this study was to evaluate the clinical and pathological impact of adrenal metastases in a large series of patients. PATIENTS Four hundred and sixty-four patients (288 men, 176 women) with metastatic disease in the adrenal glands over a 30-year period were included in the study. MEASUREMENTS The clinical records and pathological features were reviewed. RESULTS The frequencies of adrenal metastases at autopsies, adrenalectomies and fine-needle aspiration biopsies were 3.1%, 7.5% and 33%, respectively. The lesions were often seen in elderly patients (mean age, 62, SD = 13 years). Many of the metastatic lesions in the adrenal gland occurred shortly after the detection of a primary tumour (mean latent period = 7 months). Four per cent of the adrenal lesions (n = 20) were symptomatic. The symptomatic adrenal lesions, as compared with asymptomatic ones, were bigger and seen in younger patients. Five patients presented with adrenal insufficiency (Addison's disease) and one had massive peritoneal haemorrhage because of metastatic carcinoma. Ninety per cent (n = 421) of the metastatic adrenal tumours were carcinomas and 56% of these were adenocarcinoma. Lung was the most common primary tumour site (35%), followed by the stomach (14%), the oesophagus (12%) and the liver/bile ducts (10%). The adrenal metastases were bilateral in approximately half of the patients (49%, n = 229). The mean diameter of the adrenal metastases was 2 cm (SD = 1.9 cm). The mean weight of the right adrenal gland harbouring the metastasis was 19 g, while that of the left 20 g. The median survival of the 20 patients with symptomatic adrenal lesions was 3 months (range, 0-75 months) after the detection of adrenal metastases. Patients with surgically removed adrenal metastases had slightly better survival rates than those without surgical resection. CONCLUSIONS A variety of tumours may give rise to adrenal metastases. They are often asymptomatic and detected as part of multiorgan metastases. Symptomatic cases, albeit rare, may occur. Long-term survival may be achieved in selected patients in whom an aggressive surgical approach may be adopted.
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Affiliation(s)
- K-Y Lam
- School of Medicine, James Cook University, Townsville, Australia.
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41
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Abstract
Patients with malignancy may present with acute circulatory compromise requiring ICU monitoring and care. The clinician must be familiar with a multiplicity of acute and chronic medical conditions common to the general population and also with conditions directly related to cancer or therapy thereof.
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Affiliation(s)
- A Bogolioubov
- Division of Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Kuyama A, Takeuchi M, Munemasa M, Tsutsui K, Aga N, Goda Y, Kanetada K. Successful treatment of primary adrenal non-Hodgkin's lymphoma associated with adrenal insufficiency. Leuk Lymphoma 2000; 38:203-5. [PMID: 10811465 DOI: 10.3109/10428190009060336] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a case of primary adrenal NHL associated with adrenal insufficiency which was successfully treated with steroid replacement and chemotherapy. A 69-year-old woman hospitalized with fatigue and weight loss developed shock and recovered with steroid therapy. Adrenal insufficiency was confirmed by an elevated plasma adrenocorticotropic hormone level and low cortisol. Computed tomography revealed large bilateral adrenal masses. Needle biopsy showed a diffuse, mixed B cell lymphoma. CHOP therapy accompanied by steroid replacement was begun, and she achieved a complete remission after 4 cycles. She received additional 4 cycles of chemotherapy. Although adrenal insufficiency was irreversible, she has continued in complete remission for 50 months at this reporting.
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Affiliation(s)
- A Kuyama
- Department of Internal Medicine, Yashima General Hospital, Takamatsu
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Abstract
Primary adrenal lymphoma is a rare primary neoplastic disease of the adrenal glands, with up to 65 cases reported in the literature over the past 40 years. The increasing use and sophistication of medical diagnostic imaging has allowed this disease to be diagnosed more frequently premortem, presenting more opportunity for treatment. The true incidence of these neoplasms is not known, nor is it clear why historical autopsy series have not reported this neoplasm more frequently, and why its existence has been documented more recently with advanced diagnostic imaging. This review has presented our new case, and reviewed 5 more in the literature, bringing the total number of cases to over 70. Accumulation of more cases and the experience treating these cases is needed to develop a better picture of diagnostic procedures and treatment regimens that have maximum efficacy.
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Affiliation(s)
- J R Salvatore
- Division of Medical Oncology-Hematology, Maricopa Medical Center, Phoenix, AZ, USA
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Lee JE, Evans DB, Hickey RC, Sherman SI, Gagel RF, Abbruzzese MC, Abbruzzese JL. Unknown primary cancer presenting as an adrenal mass: frequency and implications for diagnostic evaluation of adrenal incidentalomas. Surgery 1998; 124:1115-22. [PMID: 9854592 DOI: 10.1067/msy.1998.92009] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fine-needle aspiration biopsy to identify adrenal metastasis from an occult primary malignancy has been recommended as part of the evaluation of the patient who presents with an incidentally discovered adrenal mass. This recommendation was assessed by examining the frequency of adrenal involvement in patients with suspected unknown primary cancer. METHODS Data from 1715 patients referred for evaluation of suspected unknown primary cancer were retrospectively reviewed. RESULTS Of 1639 patients found to have cancer, the adrenal gland was identified as a site of involvement at presentation in 95 (5.8%). Involvement was limited to the adrenal gland in 4 patients (0.2%). All 4 patients had large (> or = 6 cm) adrenal tumors, 3 of 4 had bilateral involvement, and all had symptoms that otherwise mandated evaluation for an occult malignancy; none had a true adrenal incidentaloma. CONCLUSIONS Although cancer of an unknown primary site occasionally involves the adrenal gland, metastatic cancer presenting as a true adrenal incidentaloma is extremely rare. Therefore, in the absence of a history of prior malignancy or symptoms, physical examination findings, radiographic findings, or laboratory findings suggestive of an occult malignancy, we do not recommend fine-needle aspiration biopsy as part of the diagnostic evaluation of the patient who presents with a unilateral adrenal mass.
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Affiliation(s)
- J E Lee
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston 77030, USA
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45
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Levy NT, Young WF, Habermann TM, Strickler JG, Carney JA, Stanson AW. Adrenal insufficiency as a manifestation of disseminated non-Hodgkin's lymphoma. Mayo Clin Proc 1997; 72:818-22. [PMID: 9294527 DOI: 10.4065/72.9.818] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To analyze the clinical characteristics, laboratory features, and outcome in five patients who had biochemically proven adrenal insufficiency attributable to pathologically confirmed non-Hodgkin's lymphoma (NHL). MATERIAL AND METHODS We retrospectively reviewed the medical records of all patients at Mayo Clinic Rochester during the period from 1976 to 1994 to identify those with both NHL, as listed in the surgical pathology tissue registry, and adrenal insufficiency. Histologically, the patients were classified on the basis of the working formulation and the revised European-American lymphoma classification. RESULTS Three patients had diffuse large cell NHL, one patient had small noncleaved NHL, and one patient had cutaneous T-cell NHL. All five patients had stage IV disease. Adrenal insufficiency was confirmed by morning and evening determinations of serum cortisol levels and cosyntropin stimulation tests. All patients demonstrated loss of circadian rhythm. The median age of the patients was 77 years (range, 60 to 89). Three of the five patients died without treatment from 5 to 22 days after assessment. One patient died of a cerebrovascular accident. Despite initiation of chemotherapy, two patients died of progressive NHL at 7 weeks and 7 months. CONCLUSION In our experience, biochemically proven adrenal insufficiency in patients with NHL is a manifestation of clinically advanced disease in elderly patients. A stepwise diagnostic approach is critical for the appropriate management of such patients.
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Affiliation(s)
- N T Levy
- Department of Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA
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46
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Davì MV, Francia G, Brazzarola P, Olivieri M, Petrozziello A, Orsolini A, Petronio R, Sussi PL. An unusual case of adrenal failure due to isolated metastases of breast cancer. J Endocrinol Invest 1996; 19:488-9. [PMID: 8884545 DOI: 10.1007/bf03349896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe a patient affected by adrenal insufficiency due to metastases of breast cancer. Adrenal involvement became clinically evident 20 years after radical mastectomy and it was the only secondary localization of the tumor. There is still no evidence of other metastases after a two year follow-up. This case suggests that adrenal function evaluation should be included in periodical follow-ups of patients who underwent radical mastectomy for breast cancer.
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Affiliation(s)
- M V Davì
- Istituto di Semeiotica e Nefrologia Medica, Cattedra di Endocrinochirurgia, Università di Verona, Italy
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Gross MD, Shapiro B, Francis IR, Bree RL, Korobkin M, McLeod MK, Thompson NW, Sanfield JA. Scintigraphy of incidentally discovered bilateral adrenal masses. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1995; 22:315-21. [PMID: 7607261 DOI: 10.1007/bf00941847] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to determine the patterns of iodine-131 6 beta-iodomethylnorcholesterol (NP-59) imaging and the correlation with computed tomography (CT)-guided adrenal biopsy and follow-up in patients with bilateral adrenal masses. To this end we investigated a consecutive sample of 29 euadrenal patients with bilateral adrenal masses discovered on CT for reasons other than suspected adrenal disease. Adrenal scintigraphy was performed using 1 mCi of NP-59 injected intravenously, with gamma camera imaging 5-7 days later. In 13 of the 29 patients bilateral adrenal masses were the result of metastatic involvement from lung carcinoma (5), lymphoma (3), adrenocarcinoma of the colon (3), squamous cell carcinoma of the larynx (1), and anaplastic carcinoma of unknown primary (1). Among these cases the NP-59 scan demonstrated either bilaterally absent tracer accumulation (in eight, all with bilateral metastases proven by CT-guided biopsy or progression on follow-up CT) or marked asymmetry of adrenocortical NP-59 uptake (in five). Biopsy of the adrenal demonstrating the least NP-59 uptake documented malignant involvement of that gland in five of five patients. In two patients an adenoma was found simultaneously in one adrenal with a contralateral malignant adrenal mass. In each of these cases, the adenoma demonstrated the greatest NP-59 uptake. In 16 patients diagnosis of adenoma was made on the basis of (a) CT-guided adrenal biopsy of the gland with the greatest NP-59 uptake of the pair (n = 4), or (b) adrenalectomy (n = 2), or (c) absence of change in the size of the adrenal mass on follow-up CT scanning performed 6 months to 3 years later (n = 10).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M D Gross
- Department of Internal Medicine (Division of Nuclear Medicine), University of Michigan, Ann Arbor, USA
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48
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Abstract
The authors report a patient with a primary lymphoma of the adrenal glands presenting as acute adrenal failure. Fine-needle aspiration biopsy of the adrenal glands revealed a non-Hodgkin lymphoma of predominantly small cleaved cells and a low degree of malignancy. The absence of abnormal findings in clinical, bone marrow, and computed tomography scan examinations supports the diagnosis of primary non-Hodgkin lymphoma of the adrenal glands. Chemotherapy produced a complete functional recovery, and tumoral masses disappeared after the first three cycles of treatment.
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Affiliation(s)
- S Serrano
- Department of Internal Medicine, Hospital Comarcal del Noroeste, Caravaca, Murcia, Spain
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49
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Affiliation(s)
- R F Pommier
- Memorial Sloan-Kettering Cancer Center, New York, New York
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50
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Frederick R, Brown C, Renusch J, Turner L. Addisonian crisis: emergency presentation of primary adrenal insufficiency. Ann Emerg Med 1991; 20:802-6. [PMID: 2064104 DOI: 10.1016/s0196-0644(05)80846-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R Frederick
- Division of Emergency Medicine, University of Illinois College of Medicine, Saint Francis Medical Center, Peoria 61637
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