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Zhelev K, Mihaylova-Hristov M, Conev N, Cholakova M, Korabova B, Petrov I, Georgieva N, Nedev N, Mihaylova I, Petrova M, Zahariev Z, Donev I. Lower fluorodeoxyglucose positron emission tomography maximum standardized uptake value may show a better response to stereotactic body radiotherapy of adrenals in oligometastatic disease. Contemp Oncol (Pozn) 2024; 27:263-268. [PMID: 38405207 PMCID: PMC10883199 DOI: 10.5114/wo.2023.135288] [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: 08/03/2023] [Accepted: 01/02/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Stereotactic body radiotherapy (SBRT) is well established for oligometastatic disease, and it is increasingly used to treat adrenal metastases. Material and methods In this retrospective study we performed an analysis of 75 metastatic adrenal lesions in 64 patients with oligometastatic disease. According to the fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) maximum standardized uptake value (SUVmax) of adrenal metastases, patients were categorized into three groups: low, intermediate, and high SUVmax. Results For all clinicopathological characteristics we found significant relationships for levels of SUVmax and objective response rate (Kendall Tau-c = 0.290; p = 0.017). Patients who responded to SBRT had a significantly lower SUVmax value than those who did not respond (7.6 ±2.4 vs. 9.7 ±3.8; p = 0.015). At the appropriate SUVmax cut-off values, the biomarker distinguished between patients with and without a response significantly and moderately (area under the curve = 0.670, 95% confidence intervals: 0.540-0.790; p = 0.015). Conclusions Lower SUVmax is associated with a better response to SBRT in patients whose disease progressed mainly in the adrenal glands.
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Affiliation(s)
- Kiril Zhelev
- Department of Radiotherapy, MHAT “Heart and Brain”, Pleven, Bulgaria
| | | | | | - Manoela Cholakova
- Department of Radiotherapy, MHAT “Heart and Brain”, Pleven, Bulgaria
| | - Bilyana Korabova
- Department of Radiotherapy, MHAT “Heart and Brain”, Pleven, Bulgaria
| | - Ivaylo Petrov
- Department of Radiotherapy, MHAT “Heart and Brain”, Pleven, Bulgaria
| | | | - Nikolay Nedev
- Department of Radiotherapy, MHAT “City Clinic”, Sofia, Bulgaria
| | | | - Mila Petrova
- Clinic of Medical Oncology, MHAT “Nadezhda”, Sofia, Bulgaria
| | - Zahari Zahariev
- Department of Radiotherapy, Uni Hospital, Panagyurishte, Bulgaria
| | - Ivan Donev
- Clinic of Medical Oncology, MHAT “Nadezhda”, Sofia, Bulgaria
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Liao X, Kishi K, Du K, Komaki R, Mizoe J, Aikawa G, Zheng W, Pan C. Risk factors of local control in adrenal metastases treated by stereotactic body radiation therapy - a systematic review and meta-analysis. Front Oncol 2023; 13:1193574. [PMID: 38045003 PMCID: PMC10691549 DOI: 10.3389/fonc.2023.1193574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose This study is aimed to explore risk factors affect the therapy outcomes of adrenal metastases (AM) for stereotactic body radiation therapy (SBRT) and guide clinical dose selection. Methods and materials PubMed, Embase and Web of Science were searched in September 22, 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Subgroup analysis and meta-regression were used to search for sources of heterogeneity and identify risky outcomes factors. Publication bias test and sensitivity analysis were also conducted. Results Thirty-three studies with full text from 2009 to 2022 about AM with SBRT on 1483 patients were included. Pooled 1- and 2-year local control (LC) and overall survival(OS) were 81.7% (95% confidence interval [CI], 75.6%-86.5%), 62.8% (95% CI, 53.8%-71.8%), 67.4% (95%CI, 61.8%-73.1%) and 46.5% (95%CI, 40.4%-52.6%), respectively. Biological effective dose (BED, α/β=10Gy) and dose per fraction affected 1-year LC (Qm=23.89, 15.10; P<0.0001, 0.0001). In the range of 60-80Gy (BED10), the group of dose per fraction ≥ 9Gy achieved the excellent 1-year LC (< 9Gy: ≥ 9Gy =78%, 91%; χ2 = 10.16, P = 0.001). Tracking technology significantly affected 1- and 2-year OS (Qm = 5.73, 8.75; P = 0.017, 0.003) and high tracking adoption group showed excellent 1- and 2- year OS (78.7% [95%CI, 68.6%- 88.9%]; and 62.9% [95%CI, 53.1%-72.7%]). Conclusion Increasing the dose per fraction appropriately may help control locally AM lesious. Tracking technology might contribute to improve survival of advanced patients with AM. But these results need prospective studies to verify them.
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Affiliation(s)
- Xuehong Liao
- Department of Pathology, Zhongshan Hospital, Xiamen University, Xiamen, China
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kazushi Kishi
- Department of Radiation Oncology, National Disaster Medical Center, National Hospital Organization (NHO), Incorporated Administrative Agency 3256 Tachitawa City, Tokyo, Japan
| | - Kaixin Du
- Department of Radiation Oncology, Xiamen Humanity Hospital Fujian Medical University, Xiamen, China
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ritsuko Komaki
- Department of Radiation Oncology, Emeritus of The University of Texas M.D. Anderson Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Junetsu Mizoe
- Department of Sapporo High Functioning Radiotherapy Center, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Gosuke Aikawa
- Department of Sapporo High Functioning Radiotherapy Center, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Wei Zheng
- Department of Pathology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Chao Pan
- Department of Pathology, Zhongshan Hospital, Xiamen University, Xiamen, China
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Tomatis S, Mancosu P, Reggiori G, Lobefalo F, Gallo P, Lambri N, Paganini L, La Fauci F, Bresolin A, Parabicoli S, Pelizzoli M, Navarria P, Franzese C, Lenoci D, Scorsetti M. Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management. Curr Oncol 2023; 30:7031-7042. [PMID: 37504370 PMCID: PMC10378035 DOI: 10.3390/curroncol30070510] [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: 05/22/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Hypo-fractionation can be an effective strategy to lower costs and save time, increasing patient access to advanced radiation therapy. To demonstrate this potential in practice within the context of temporal evolution, a twenty-year analysis of a representative radiation therapy facility from 2003 to 2022 was conducted. This analysis utilized comprehensive data to quantitatively evaluate the connections between advanced clinical protocols and technological improvements. The findings provide valuable insights to the management team, helping them ensure the delivery of high-quality treatments in a sustainable manner. METHODS Several parameters related to treatment technique, patient positioning, dose prescription, fractionation, equipment technology content, machine workload and throughput, therapy times and patients access counts were extracted from departmental database and analyzed on a yearly basis by means of linear regression. RESULTS Patients increased by 121 ± 6 new per year (NPY). Since 2010, the incidence of hypo-fractionation protocols grew thanks to increasing Linac technology. In seven years, both the average number of fractions and daily machine workload decreased by -0.84 ± 0.12 fractions/year and -1.61 ± 0.35 patients/year, respectively. The implementation of advanced dose delivery techniques, image guidance and high dose rate beams for high fraction doses, currently systematically used, has increased the complexity and reduced daily treatment throughput since 2010 from 40 to 32 patients per 8 h work shift (WS8). Thanks to hypo-fractionation, such an efficiency drop did not affect NPY, estimating 693 ± 28 NPY/WS8, regardless of the evaluation time. Each newly installed machine was shown to add 540 NPY, while absorbing 0.78 ± 0.04 WS8. The COVID-19 pandemic brought an overall reduction of 3.7% of patients and a reduction of 0.8 fractions/patient, to mitigate patient crowding in the department. CONCLUSIONS The evolution of therapy protocols towards hypo-fractionation was supported by the use of proper technology. The characteristics of this process were quantified considering time progression and organizational aspects. This strategy optimized resources while enabling broader access to advanced radiation therapy. To truly value the benefit of hypo-fractionation, a reimbursement policy should focus on the patient rather than individual treatment fractionation.
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Affiliation(s)
- Stefano Tomatis
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Pietro Mancosu
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Giacomo Reggiori
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Francesca Lobefalo
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Pasqualina Gallo
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Nicola Lambri
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Lucia Paganini
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Francesco La Fauci
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Andrea Bresolin
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Sara Parabicoli
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Marco Pelizzoli
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Domenico Lenoci
- Development Strategic Initiatives Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
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4
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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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Kekilli E, Demirkasımoğlu T. The efficacy and outcomes of stereotactic body radiotherapy in adrenal gland metastases. J Cancer Res Ther 2023; 19:S47-S51. [PMID: 37147982 DOI: 10.4103/jcrt.jcrt_891_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Aim This retrospective study presents our single-institutional experience with stereotactic body radiotherapy for adrenal gland metastases. Materials and Methods We evaluated patients with adrenal metastases treated by stereotactic body radiotherapy (SBRT) from 2014 to 2020. We performed an analysis of 35 patients. The median age of the patients was 62.2. Dosimetric parameters and treatment outcomes were evaluated. Results The primary diagnosis of the majority of patients was non-small cell lung cancer (94.3%). Treatment was performed in a median of 3 fractions, and the median prescribed dose was 24 Gy (range 22,5-27). The median follow-up was 17 months. Treatment response according to Response Evaluation Criteria in Solid Tumours was categorized as complete response in 11 patients, partial response in nine patients, stable disease in 7, and progressive disease in eight patients. Twenty seven patients had oligometastatic disease and treatment response. Patients with oligometastatic disease had a significantly higher rate of complete response and partial response to treatment than patients with common disease (P = 0,011). The 6-month and 1-year local control rates were 68.4% and 43%, respectively. In general, SBRT was well tolerated and no acute toxicities were observed. Conclusion Our retrospective study shows that SBRT can be applied safely in adrenal metastases with good results especially in patients with oligometastatic disease.
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Affiliation(s)
- Esra Kekilli
- Department of Radiation Oncology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Taciser Demirkasımoğlu
- Department of Radiation Oncology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
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6
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Xu B, Zhao X, Chen D, Zhao W, Wang X, Ding C, Yuan Z, Zhang H. Two-institution results of Stereotactic Body Radiation Therapy (SBRT) for treating adrenal gland metastases from liver cancer. BMC Cancer 2023; 23:73. [PMID: 36681809 PMCID: PMC9862519 DOI: 10.1186/s12885-023-10519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Stereotactic Body Radiation Therapy (SBRT) has been found beneficial for adrenal gland metastases (AGMs) with a high local control rate and low toxicity. The role of SBRT for AGMs in patients with liver cancer has not been well-discussed before. We, therefore, report our two-institution experience to further elaborate on the feasibility and effectiveness of SBRT in the treatment of AGMs from liver cancer. METHODS A total of 23 liver cancer patients (19 males, 4 females) with 24 AGMs treated by SBRT from July 2006 to April 2021 were retrospectively included in this study. Toxicity was assessed based on clinical adverse events using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The effectiveness was assessed based on local control (LC), progression-free survival (PFS), and overall survival (OS), which were calculated using the Kaplan-Meier method. Univariate analyses were compared by log-rank test. The relevant covariates were evaluated using Cox proportional hazards models. RESULTS The median dose was 40 Gy in 5 fractions, with the corresponding median biological effective dose (BED10, α/β = 10 Gy) of 72 Gy. The median overall follow-up time was 15.4 months (range: 4.2-70.6 months). The complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) rates were 25.0%, 20.8%, 33.3%, and 20.8%, respectively. All 6 patients with AGMs accompanying symptoms had varying degrees of alleviation after SBRT. The 0.5-, 1-year and 2-year LC rates were 87.5%, 77.8%, and 77.8%, respectively. The 0.5-, 1-year and 2-year OS rates were 95.5%, 66.8%, and 41.1%, respectively. The treatments were all tolerated with only one patient reporting a grade-3 hepatic injury. The univariate analysis concluded that only gross tumor volume (GTV) < 34.5 ml (p = 0.039) was associated with a favorable LC rate. After multivariate analysis, favorable predictors correlated with OS were GTV < 34.5 ml (p = 0.043), systemic therapy (p = 0.017), and without additional organ metastasis after SBRT (p = 0.009). CONCLUSION Our results suggest that SBRT is a safe and effective technique to treat AGM from liver cancer, especially for small GTV (< 34.5ml). Moreover, the small metastatic lesion volume, fewer metastatic lesions, and intervention of systemic therapy are more likely to improve OS.
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Affiliation(s)
- Bichun Xu
- Department of Radiation Oncology, Shanghai Changhai Hospital, the Navy Medical University, 200433, Shanghai, China
| | - Xianzhi Zhao
- Department of Radiation Oncology, Shanghai Changhai Hospital, the Navy Medical University, 200433, Shanghai, China
| | - Di Chen
- Department of Radiation Oncology, Shanghai Changhai Hospital, the Navy Medical University, 200433, Shanghai, China
| | - Wenjuan Zhao
- Department of Radiation Oncology, Shanghai Changhai Hospital, the Navy Medical University, 200433, Shanghai, China
| | - Xiaoyan Wang
- Department of Radiation Oncology, Shanghai Changhai Hospital, the Navy Medical University, 200433, Shanghai, China
| | - Changhua Ding
- Department of Radiation Oncology, Shanghai Changhai Hospital, the Navy Medical University, 200433, Shanghai, China
| | - Zhiyong Yuan
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 300060, Tianjin, China
| | - Huojun Zhang
- Department of Radiation Oncology, Shanghai Changhai Hospital, the Navy Medical University, 200433, Shanghai, China.
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Michalet M, Bettaïeb O, Khalfi S, Ghorbel A, Valdenaire S, Debuire P, Aillères N, Draghici R, De Méric De Bellefon M, Charissoux M, Boisselier P, Demontoy S, Marguerit A, Cabaillé M, Cantaloube M, Keskes A, Bouhafa T, Farcy-Jacquet MP, Fenoglietto P, Azria D, Riou O. Stereotactic MR-Guided Radiotherapy for Adrenal Gland Metastases: First Clinical Results. J Clin Med 2022; 12:jcm12010291. [PMID: 36615093 PMCID: PMC9821305 DOI: 10.3390/jcm12010291] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Stereotactic MR-guided Radiotherapy (MRgRT) is an interesting treatment option for adrenal gland metastases (AGM). We reviewed data from 12 consecutive patients treated with MRgRT for an AGM in our center between 14 November 2019 and 17 August 2021. Endpoints were tolerance assessment, the impact of adaptive treatment on target volume coverage and organs at risk (OAR) sparing, local control (LC), and overall survival (OS). The majority of patients were oligometastatic (58.3%), with 6 right AGM, 5 left AGM and 1 left and right AGM. The prescribed dose was 35 to 50 Gy in 3 to 5 fractions. The median PTV V95% on the initial plan was 95.74%. The median V95% of the PTVoptimized (PTVopt) on the initial plan was 95.26%. Thirty-eight (69%) fractions were adapted. The PTV coverage was significantly improved for adapted plans compared to predicted plans (median PTV V95% increased from 89.85% to 91.17%, p = 0.0478). The plan adaptation also significantly reduced Dmax for the stomach and small intestine. The treatment was well tolerated with no grade > 2 toxicities. With a median follow-up of 15.5 months, the 1−year LC and OS rate were 100% and 91.7%. Six patients (50%) presented a metastatic progression, and one patient (8.3%) died of metastatic evolution during the follow-up. Adaptation of the treatment plan improved the overall dosimetric quality of MRI-guided radiotherapy. A longer follow-up is required to assess late toxicities and clinical results.
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Affiliation(s)
- Morgan Michalet
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
- Correspondence:
| | - Ons Bettaïeb
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Samia Khalfi
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Asma Ghorbel
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Simon Valdenaire
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Pierre Debuire
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Norbert Aillères
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Roxana Draghici
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Mailys De Méric De Bellefon
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Marie Charissoux
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Pierre Boisselier
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Sylvain Demontoy
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Alexis Marguerit
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Morgane Cabaillé
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Marie Cantaloube
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Aïcha Keskes
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Touria Bouhafa
- CHU Hassan II, Radiotherapy and Brachyterapy, 30050 Fez, Morocco
| | - Marie-Pierre Farcy-Jacquet
- Institut de Cancérologie du Gard, University Federation of Radiation Oncology of Mediterranean Occitanie, CHU Carémeau, 30900 Nîmes, France
| | - Pascal Fenoglietto
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - David Azria
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
| | - Olivier Riou
- Montpellier Cancer Institute, Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France
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8
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Borghesi S, Casamassima F, Aristei C, Grandinetti A, Di Franco R. Stereotactic radiotherapy for adrenal oligometastases. Rep Pract Oncol Radiother 2022; 27:52-56. [PMID: 35402020 PMCID: PMC8989453 DOI: 10.5603/rpor.a2021.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/11/2021] [Indexed: 01/19/2023] Open
Abstract
Approximately 50% of melanomas, 30–40% of lung and breast cancers and 10–20% of renal and gastrointestinal tumors metastasize to the adrenal gland. Metastatic adrenal involvement is diagnosed by computed tomography (CT ) with contrast medium, ultrasound (which does not explore the left adrenal gland well), magnetic resonance imaging (MRI) with contrast medium and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18FDGPET-CT ) which also evaluates lesion uptake. The simulation CT should be performed with contrast medium; an oral bolus of contrast medium is useful, given adrenal gland proximity to the duodenum. The simulation CT may be merged with PET-CT images with 18FDG in order to evaluate uptaking areas. In contouring, the radiologically visible and/or uptaking lesion provides the gross tumor volume (GTV ). Appropriate techniques are needed to overcome target motion. Single fraction stereotactic radiotherapy (SRT ) with median doses of 16–23 Gy is rarely used. More common are doses of 25–48 Gy in 3–10 fractions although 3 or 5 fractions are preferred. Local control at 1 and 2 years ranges from 44 to 100% and from 27 to 100%, respectively. The local control rate is as high as 90%, remaining stable during follow-up when BED10Gy is equal to or greater than 100 Gy. SRT-related toxicity is mild, consisting mainly of gastrointestinal disorders, local pain and fatigue. Adrenal insufficiency is rare.
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Affiliation(s)
- Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | | | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Rossella Di Franco
- Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
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9
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Buergy D, Würschmidt F, Gkika E, Hörner-Rieber J, Knippen S, Gerum S, Balermpas P, Henkenberens C, Voglhuber T, Kornhuber C, Barczyk S, Röper B, Rashid A, Blanck O, Wittig A, Herold HU, Brunner TB, Sweeney RA, Kahl KH, Ciernik FI, Ottinger A, Izaguirre V, Putz F, König L, Hoffmann M, Combs SE, Guckenberger M, Boda-Heggemann J. Stereotactic Body Radiotherapy of adrenal metastases - A dose-finding study. Int J Cancer 2022; 151:412-421. [PMID: 35383919 DOI: 10.1002/ijc.34017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 11/12/2022]
Abstract
Optimal doses for the treatment of adrenal metastases with stereotactic radiotherapy (SBRT) are unknown. We aimed to identify dose-volume cut-points associated with decreased local recurrence rates (LRR). A multicenter database of patients with adrenal metastases of any histology treated with SBRT (biologically effective dose, BED10 ≥ 50Gy, ≤ 12 fractions) was analyzed. Details on dose-volume parameters were required (planning target volume: PTV-D98%, PTV-D50%, PTV-D2%; gross tumor volume: GTV-D50%, GTV-mean). Cut-points for LRR were optimized using the R maxstat package. 196 patients with 218 lesions were included, the largest histopathological subgroup was adenocarcinoma (n = 101). Cut-point optimization resulted in significant cut-points for PTV-D50% (BED10: 73.2Gy; p = 0.003), GTV-D50% (BED10: 74.2Gy; p = 0.006), GTV-mean (BED10: 73.0Gy; p = 0.007), and PTV-D2% (BED10: 78.0Gy; p = 0.02) but not for the PTV-D98% (p = 0.06). Differences in LRR were clinically relevant (LRR ≥ doubled for cut-points that were not achieved). Further dose-escalation was not associated with further improved LRR. PTV-D50%, GTV-D50%, and GTV-mean cut-points were also associated with significantly improved LRR in the adenocarcinoma subgroup. Separate dose optimizations indicated a lower cut-point for the PTV-D50% (BED10: 69.1Gy) in adenocarcinoma lesions, other values were similar (< 2% difference). Associations of cut-points with overall survival (OS) and progression-free survival were not significant but durable freedom from local recurrence was associated with OS in a landmark model (p < 0.001). To achieve a significant improvement of LRR for adrenal SBRT, a moderate escalation of PTV-D50% BED10 > 73.2Gy (adenocarcinoma: 69.1Gy) should be considered. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daniel Buergy
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
| | | | - Eleni Gkika
- Universitätsklinikum Freiburg, Strahlenheilkunde, Freiburg, Deutschland
| | - Juliane Hörner-Rieber
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Deutschland
| | - Stefan Knippen
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Deutschland.,Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Deutschland
| | - Sabine Gerum
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, München, Deutschland.,Klinik für Radiotherapie und Radioonkologie, Paracelsus Universität Salzburg, Landeskrankenhaus, Salzburg, Österreich
| | - Panagiotis Balermpas
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Schweiz
| | - Christoph Henkenberens
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Hannover, Deutschland
| | - Theresa Voglhuber
- Technische Universität München (TUM), Department of Radiation Oncology, Ismaninger Straße 22, Munich
| | - Christine Kornhuber
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Deutschland
| | - Steffen Barczyk
- Zentrum für Strahlentherapie und Radioonkologie, Belegklinik am St. Agnes-Hospital, Bocholt, Deutschland
| | - Barbara Röper
- DIE RADIOLOGIE, MVZ Strahlentherapie Bogenhausen - Harlaching - Neuperlach, München, Deutschland
| | - Ali Rashid
- MediClin Robert Janker Klinik, Klinik für Strahlentherapie und Radioonkologie, Bonn, Deutschland
| | - Oliver Blanck
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Kiel, Deutschland
| | - Andrea Wittig
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Deutschland
| | - Hans-Ulrich Herold
- Cyberknife Centrum Mitteldeutschland GmbH, Institut für Radiochirurgie und Präzisionsbestrahlung, Erfurt, Deutschland
| | - Thomas B Brunner
- Universitätsklinikum Magdeburg, Klinik für Strahlentherapie, Magdeburg, Deutschland
| | - Reinhart A Sweeney
- Leopoldina Krankenhaus Schweinfurt, Klinik für Strahlentherapie, Schweinfurt, Deutschland
| | - Klaus Henning Kahl
- Universitätsklinikum Augsburg, Klinik für Strahlentherapie und Radioonkologie, Augsburg, Deutschland
| | - F Ilja Ciernik
- Städtisches Klinikum Dessau, Klinik für Strahlentherapie und Radioonkologie, Dessau, Deutschland
| | - Annette Ottinger
- Klinikum Darmstadt GmbH, Institut für Radioonkologie und Strahlentherapie, Darmstadt, Deutschland
| | - Victor Izaguirre
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Deutschland
| | - Florian Putz
- Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Deutschland
| | - Laila König
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Deutschland
| | - Michael Hoffmann
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, München, Deutschland
| | - Stephanie E Combs
- Technische Universität München (TUM), Department of Radiation Oncology, Ismaninger Straße 22, Munich.,Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, Neuherberg, Deutschland.,Deutsches Zentrum für Translationale Krebsforschung (DKTK) Partner Site Munich
| | - Matthias Guckenberger
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Schweiz
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
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10
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Puente-Vallejo R, Ochoa P, Núñez C, De Los Reyes L. Management of an Unusual Metastasis of Cervical Cancer in the Adrenal Bed With Stereotactic Ablative Body Radiation Therapy. Cureus 2022; 14:e22178. [PMID: 35308681 PMCID: PMC8923247 DOI: 10.7759/cureus.22178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 12/24/2022] Open
Abstract
Uterine cervical carcinoma is an important type of cancer among Ecuadorian women, especially in adult women. Survival rates have improved with the development of radiotherapy, surgical techniques, and chemotherapy. However, recurrence and/or metastasis are not unusual phenomena. Frequent sites of metastasis are the lungs, regional lymph nodes, and bones. Atypical locations can also occur on solid organs, such as adrenal glands. Treatment for the rare complication that is adrenal metastasis is individualized, it can include surgical resection, chemotherapy, local ablation, or different types of radiotherapy. We aimed to report a case of an Ecuadorian woman from Quito city with a diagnosis of cervical carcinoma diagnosed in 2009, treated surgically and with adjuvant chemotherapy. Her progression was monitored with medical controls with no recurrence until 2018, when she relapsed with a metastatic invasion of the pelvic ganglia and the surroundings of the abdominal aorta, with a histopathologic diagnosis of adenocarcinoma. She was then treated with chemotherapy and radiotherapy until June 2019. In 2020, she went through a splenectomy and left adrenalectomy to treat vascular thrombosis. In 2021, 37 x 15 mm mass was discovered in the surgical bed of the previously removed adrenal gland. It was treated as an oligometastatic carcinoma with stereotactic body radiotherapy (SBRT) by a linear accelerator.
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11
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Stereotactic body radiation therapy for adrenal gland metastases: outcome and predictive factors from a multicenter analysis. Clin Exp Metastasis 2021; 38:511-518. [PMID: 34651241 DOI: 10.1007/s10585-021-10124-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Adrenal metastases occur in 15-35% of oncological patients. Surgery is the first treatment option. Stereotactic body radiotherapy (SBRT) has been largely explored in oligometastatic patients unfit for surgery, representing an effective and non-invasive local treatment. The results of a multi-institutional experience of SBRT on adrenal metastases in the oligorecurrent or oligoprogressive setting are herein reported. We collected data of adrenal gland metastases treated with SBRT in three Italian centers from 2010 to 2020. End-points of the present study were: Overall survival (OS), Local control of treated metastases (LC), Progression free survival (PFS), and toxicity. 149 adrenal gland metastases were treated with SBRT in 142 patients. The most common primary tumor was lung cancer (58.4%), followed by kidney cancer (9.4%). Median lesion's volume was 28.5 cm3 (2.5-323.4). The median SBRT dose was 40 Gy (10-60). Median follow-up was 14.4 months. One- and two-year OS were 72.3% and 53.5%. At univariate analysis performance status correlated with survival (HR 1.57, p = 0.006). One- and two-year LC were 85.4% and 79.2%, with lung primary tumor (HR 0.33, p = 0.021) and BED10 (HR 0.97, p = 0.036) significant independent factors. One- and two-year PFS were 37.7% and 24.8%. Median time to polymetastatic disease was 11.3 months. Grade 1 and 2 toxicity occurred in 21 (14.7%) and 3 (2.1%) patients. The results from this large multi-center study confirm the efficacy and safety of SBRT in the management of adrenal gland metastases, as a valid alternative to other more invasive local approaches.
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12
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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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13
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Modeling of Tumor Control Probability in Stereotactic Body Radiation Therapy for Adrenal Tumors. Int J Radiat Oncol Biol Phys 2021; 110:217-226. [PMID: 33864824 DOI: 10.1016/j.ijrobp.2020.05.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) in the management of adrenal metastases is emerging as a well-tolerated, effective method of treatment for patients with limited metastatic disease. SBRT planning and treatment utilization are widely variable, and publications report heterogeneous radiation dose fractionation schemes and treatment outcomes. The objective of this analysis was to review the current literature on SBRT for adrenal metastases and to develop treatment guidelines and a model for tumor control probability of SBRT for adrenal metastases based on these publications. METHODS AND MATERIALS A literature search of all studies on SBRT for adrenal metastases published from 2008 to 2017 was performed, and outcomes in these studies were reviewed. Local control (LC) rates were fit to a statistically significant Poisson model using maximum likelihood estimation techniques. RESULTS One-year LC greater than 95% was achieved at an approximated biological equivalent dose with α/β = 10 Gy of 116.4 Gy. CONCLUSIONS While respecting normal tissue tolerances, tumor doses greater than or equal to a biological equivalent dose with α/β = 10 Gy of 116.4 Gy are recommended to achieve high LC. Further studies following unified reporting standards are needed for more robust prediction.
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14
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Reshko LB, Gaskins JT, Silverman CL, Dunlap NE. Stereotactic body radiation therapy (SBRT) of adrenal gland metastases in oligometastatic and oligoprogressive disease. Rep Pract Oncol Radiother 2021; 26:325-340. [PMID: 34277086 PMCID: PMC8281902 DOI: 10.5603/rpor.a2021.0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/23/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) as a form of noninvasive treatment that is becoming increasingly used to manage cancers with adrenal gland metastases. There is a paucity of data on safety and efficacy of this modality. The aim of the study was to evaluate the safety and efficacy of adrenal gland SBRT in oligometastatic and oligoprogressive disease. MATERIALS AND METHODS In this retrospective study, we performed a single-institution analysis of 26 adrenal lesions from 23 patients with oligometastatic or oligoprogressive disease treated from 2013 to 2019 with the goal of achieving durable local control. Palliative cases were excluded. Radiation dosimetry data was collected. Kaplan Meier product estimator and Cox proportional hazards regression analysis were used for statistical analysis. RESULTS The median dose was 36 Gy in 3 fractions (range: 24-50 Gy and 3-6 fractions) with a median biologically effective dose (BED10) of 72 (range: 40-100). 1-year local control rate was 80% and median local control was not achieved due to a low number of failures. 1- and 2-year overall survival rates were 66% and 32%. Toxicity was mild with only one case of grade 2 nausea and no grade 3-5 toxicity. Higher neutrophil to lymphocyte ratio was associated with worse overall survival and a trend toward worse progression-free survival. In addition, worse performance status and lower BED10 were associated with worse survival. No such association could be shown for primary tumor location, histology, size or stage. CONCLUSION Adrenal SBRT for oligometastatic or oligoprogressive disease is a safe and effective form of treatment.
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Affiliation(s)
- Leonid B Reshko
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, United States of America
| | - Jeremy T Gaskins
- Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, United States of America
| | - Craig L Silverman
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, United States of America
| | - Neal E Dunlap
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, United States of America
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15
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Buergy D, Würschmidt F, Gkika E, Hörner-Rieber J, Knippen S, Gerum S, Balermpas P, Henkenberens C, Voglhuber T, Kornhuber C, Barczyk S, Röper B, Rashid A, Blanck O, Wittig A, Herold HU, Brunner TB, Klement RJ, Kahl KH, Ciernik IF, Ottinger A, Izaguirre V, Putz F, König L, Hoffmann M, Combs SE, Guckenberger M, Boda-Heggemann J. Stereotactic or conformal radiotherapy for adrenal metastases: Patient characteristics and outcomes in a multicenter analysis. Int J Cancer 2021; 149:358-370. [PMID: 33682927 DOI: 10.1002/ijc.33546] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 01/17/2023]
Abstract
To report outcome (freedom from local progression [FFLP], overall survival [OS] and toxicity) after stereotactic, palliative or highly conformal fractionated (>12) radiotherapy (SBRT, Pall-RT, 3DCRT/IMRT) for adrenal metastases in a retrospective multicenter cohort within the framework of the German Society for Radiation Oncology (DEGRO). Adrenal metastases treated with SBRT (≤12 fractions, biologically effective dose [BED10] ≥ 50 Gy), 3DCRT/IMRT (>12 fractions, BED10 ≥ 50 Gy) or Pall-RT (BED10 < 50 Gy) were eligible for this analysis. In addition to unadjusted FFLP (Kaplan-Meier/log-rank), we calculated the competing-risk-adjusted local recurrence rate (CRA-LRR). Three hundred twenty-six patients with 366 metastases were included by 21 centers (median follow-up: 11.7 months). Treatment was SBRT, 3DCRT/IMRT and Pall-RT in 260, 27 and 79 cases, respectively. Most frequent primary tumors were non-small-cell lung cancer (NSCLC; 52.5%), SCLC (16.3%) and melanoma (6.7%). Unadjusted FFLP was higher after SBRT vs Pall-RT (P = .026) while numerical differences in CRA-LRR between groups did not reach statistical significance (1-year CRA-LRR: 13.8%, 17.4% and 27.7%). OS was longer after SBRT vs other groups (P < .05) and increased in patients with locally controlled metastases in a landmark analysis (P < .0001). Toxicity was mostly mild; notably, four cases of adrenal insufficiency occurred, two of which were likely caused by immunotherapy or tumor progression. Radiotherapy for adrenal metastases was associated with a mild toxicity profile in all groups and a favorable 1-year CRA-LRR after SBRT or 3DCRT/IMRT. One-year FFLP was associated with longer OS. Dose-response analyses for the dataset are underway.
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Affiliation(s)
- Daniel Buergy
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
| | | | - Eleni Gkika
- Universitätsklinikum Freiburg, Strahlenheilkunde, Freiburg, Germany
| | - Juliane Hörner-Rieber
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Germany
| | - Stefan Knippen
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Germany.,Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Germany
| | - Sabine Gerum
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, Munich, Germany.,Klinik für Radiotherapie und Radioonkologie, Paracelsus Universität Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Panagiotis Balermpas
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Switzerland
| | - Christoph Henkenberens
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Hannover, Germany
| | - Theresa Voglhuber
- Technische Universität München (TUM), Department of Radiation Oncology, Munich, Germany
| | - Christine Kornhuber
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Germany
| | - Steffen Barczyk
- Zentrum für Strahlentherapie und Radioonkologie, Belegklinik am St. Agnes-Hospital, Bocholt, Germany
| | - Barbara Röper
- Gemeinschaftspraxis für Strahlentherapie, Bogenhausen - Harlaching - Neuperlach, Munich, Germany
| | - Ali Rashid
- MediClin Robert Janker Klinik, Klinik für Strahlentherapie und Radioonkologie, Bonn, Germany
| | - Oliver Blanck
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Kiel, Germany
| | - Andrea Wittig
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Germany
| | - Hans-Ulrich Herold
- Cyberknife Centrum Mitteldeutschland GmbH, Institut für Radiochirurgie und Präzisionsbestrahlung, Erfurt, Germany
| | - Thomas B Brunner
- Universitätsklinikum Magdeburg, Klinik für Strahlentherapie, Magdeburg, Germany
| | - Rainer J Klement
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Switzerland.,Leopoldina Krankenhaus Schweinfurt, Klinik für Strahlentherapie, Schweinfurt, Germany
| | - Klaus Henning Kahl
- Universitätsklinikum Augsburg, Klinik für Strahlentherapie und Radioonkologie, Augsburg, Germany
| | - Ilja F Ciernik
- Städtisches Klinikum Dessau, Klinik für Strahlentherapie und Radioonkologie, Dessau, Germany
| | - Annette Ottinger
- Klinikum Darmstadt GmbH, Institut für Radioonkologie und Strahlentherapie, Darmstadt, Germany
| | - Victor Izaguirre
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Germany
| | - Florian Putz
- Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Germany
| | - Laila König
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Germany
| | - Michael Hoffmann
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Klinikum der Universität München, LMU, Munich, Germany
| | - Stephanie E Combs
- Technische Universität München (TUM), Department of Radiation Oncology, Munich, Germany.,Helmholtz Zentrum München (HMGU), Neuherberg, Germany.,Deutsches Zentrum für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Matthias Guckenberger
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Switzerland
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
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16
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Zhao R, Ma Y, Yang S, Liu Q, Tang Y, Wang K, Zhang Y, Bi N, Zhang H, Yi J, Li Y, Luo J, Xiao J. Hypofractionated Radiotherapy for 35 Patients with Adrenal Metastases: A Single-Institution Experience. Cancer Manag Res 2020; 12:11563-11571. [PMID: 33209060 PMCID: PMC7669511 DOI: 10.2147/cmar.s278781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/27/2020] [Indexed: 12/22/2022] Open
Abstract
Objective To investigate the clinical outcomes of hypofractionated radiotherapy for adrenal metastases. Materials and Methods We retrospectively reviewed patients diagnosed with adrenal metastases and treated with hypofractionated radiotherapy, who did not receive adrenalectomy or have disease progression after chemotherapy, from 2007 to 2019. The Kaplan–Meier method was used to estimate local control rate (LCR), progression-free survival (PFS), and overall survival (OS). Univariate analysis was performed using Log rank test. Results Thirty-five patients with 42 lesions were enrolled, and the lung was the most common primary site (80.0%). The median follow-up time was 46.4 months. The median volume of GTV and PTV was 23.2 cm3 (range: 3.5–97.8 cm3) and 38.3 cm3 (range: 10.2–135.6 cm3), respectively. The main dose regimens were 60 Gy delivered in 4–15 fractions, with the median dose of PTV being 60 Gy (range: 40–66.3 Gy) and the biologically effective dose (BED) being 84 Gy (range: 56–110 Gy). The 1-year and 2-year LCR, OS, and PFS were 92.7% and 88.1%, 76.9% and 45.4%, and 25.1% and 14.4%, respectively. Univariate analysis showed that chemotherapy, disease-free interval from primary disease diagnosis to adrenal metastases diagnosis, and age were significant factors for LCR, OS, and PFS, respectively (p=0.017, 0.049, and 0.004, respectively). No more than grade III toxicities were observed. Conclusion As a non-invasive approach, hypofractionated radiotherapy is safe and effective for metastatic adrenal lesions, without serious complications.
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Affiliation(s)
- Ruizhi Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Yuchao Ma
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Siran Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Qingfeng Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Hongmei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
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Helis CA, Hughes RT, Nieto K, Ufondu A, Daugherty EC, Farris MK. Adrenal SBRT: a multi-institutional review of treatment outcomes and toxicity. Clin Exp Metastasis 2020; 37:585-592. [PMID: 32700208 DOI: 10.1007/s10585-020-10052-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/15/2020] [Indexed: 12/25/2022]
Abstract
The adrenal glands are a common site of metastatic disease. Definitive treatment for oligometastatic disease using ablative radiotherapy is becoming common in modern radiation oncology practice. However, most data on the treatment of adrenal metastases are limited to single institution reports. Furthermore, delivering ablative radiotherapy doses to intra-abdominal lesions can be challenging due to the proximity of the gastrointestinal tract. We report the outcomes of a multi-institutional cohort of patients treated with definitive radiotherapy for adrenal metastases, primarily using 10 fraction regimens. Retrospective review of institutional databases revealed 29 lesions in 27 patients were treated from 2005 to 2018 at two institutions. Outcome data, including local control, disease-free, and overall survival were abstracted from the medical record system. Toxicity was graded using CTCAE v5.0. Detailed radiotherapy data was abstracted from the treatment planning systems. The median dose was 50 Gy in 10 fractions. Actuarial 1 and 2 year local control was 86% and 76% respectively. The median overall and disease-free survival were 22.8 and 5.6 months respectively. There were no associations identified between local failure and GTV and PTV physical or biologic effective dose. Two patients developed late Grade 3 gastrointestinal toxicity. High dose radiotherapy to adrenal metastases is a feasible treatment with excellent local control and a reasonable safety profile. For lesions in close proximity to gastrointestinal structures, moderately hypofractionated 10 fraction regimens may be a reasonable compromise between local control and toxicity.
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Affiliation(s)
- Corbin A Helis
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Karina Nieto
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Adannia Ufondu
- Department of Radiation Oncology, University of Cincinnati Cancer Institute, Cincinnati, OH, 45219, USA
| | - Emily C Daugherty
- Department of Radiation Oncology, University of Cincinnati Cancer Institute, Cincinnati, OH, 45219, USA
| | - Michael K Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
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Arcidiacono F, Aristei C, Marchionni A, Italiani M, Fulcheri CPL, Saldi S, Casale M, Ingrosso G, Anselmo P, Maranzano E. Stereotactic body radiotherapy for adrenal oligometastasis in lung cancer patients. Br J Radiol 2020; 93:20200645. [PMID: 32822540 DOI: 10.1259/bjr.20200645] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To report our experience on stereotactic body radiotherapy (SBRT) in adrenal metastases from lung cancer. METHODS 37 oligometastatic lung cancer patients with 38 adrenal metastases submitted to SBRT were retrospectively analyzed. SBRT was delivered by volumetric modulated arc therapy (VMAT) or helical tomotherapy (HT). Primary study end point was local recurrence-free survival (LR-FS) and secondary end points were distant-progression free survival (d-PFS) and overall survival (OS). RESULTS Median age was 67 years and primary tumor was non-small-cell lung cancer in 27 (73%) and small-cell lung cancer in 10 (27%) patients. Adrenal metastases were in the left side in 66% cases. Median prescribed dose was 30 Gy in 5 fractions for a median biologically equivalent dose (α/β ratio 10 Gy, BED10) of 48 Gy. Most patients (62%) were submitted to SBRT alone, while the others (38%) received chemo-, immune- or target- therapies. Median follow-up was 10.5 months, median OS 16 months and median d-PFS 3 months. 27 (70%) patients obtained a local control with a median LR-FS of 32 months. LR-FS was significantly related to BED10 with a better LC with BED10 ≥72 Gy, 1- and 2 year LR-FS rates were 54.1±11.6% and 45±12.7% vs 100 and 100% for BED ≤59.5 Gy and BED ≥72 Gy, respectively (p = 0.05). There was no severe toxicity. CONCLUSION SBRT was effective and safe in lung cancer adrenal metastases. A dose-response relationship was found between BED10 >72 Gy and better local control. No significant toxicity was registered thanks to the respect of dose constraints and suspension of chemo- and target-therapies. ADVANCES IN KNOWLEDGE SBRT with a BED10 >72 Gy is an effective treatment for adrenal oligometastatic lung cancer patients.
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Affiliation(s)
| | - Cynthia Aristei
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Alessandro Marchionni
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Marco Italiani
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | - Simonetta Saldi
- Radiotherapy Oncology Centre, "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | | | - Gianluca Ingrosso
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
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Franzese C, Badalamenti M, Comito T, Franceschini D, Clerici E, Navarria P, Loi M, D'agostino G, Baldaccini D, Chiola I, Reggiori G, Mancosu P, Tomatis S, Scorsetti M. Assessing the role of Stereotactic Body Radiation Therapy in a large cohort of patients with lymph node oligometastases: Does it affect systemic treatment’s intensification? Radiother Oncol 2020; 150:184-190. [DOI: 10.1016/j.radonc.2020.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023]
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Stereotactic body radiotherapy in the management of oligometastatic and recurrent biliary tract cancer: single-institution analysis of outcome and toxicity. J Cancer Res Clin Oncol 2020; 146:2289-2297. [PMID: 32524292 DOI: 10.1007/s00432-020-03285-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Biliary tract cancers (BTC) are rare malignancies arising from biliary system. Systemic therapy is the cornerstone for stage IV disease, with poor overall survival (OS). Evidence is lacking about safety and efficacy of local ablative treatments, such as surgery and stereotactic body radiotherapy (SBRT) in the context of metastatic BTC (mBTC). MATERIALS AND METHODS We retrospectively analyzed clinical outcomes for a cohort of mBTC patients treated with SBRT for oligometastatic disease. Inclusion criteria were 1-5 distant metastases; SBRT with a dose/fraction of a least 5 Gy to a biological effective dose (BED) of at least 40 Gy considering an α/β of 10 Gy. Analyzed outcomes included local control (LC), distant progression-free survival (DPFS), PFS, and OS. RESULTS 51 patients meeting the inclusion criteria. Primary tumor sites were intrahepatic cholangiocarcinoma (35%), extrahepatic cholangiocarcinoma (31%), ampullary adenocarcinoma (20%), gallbladder adenocarcinoma (14%). 21 patients were treated on liver lesions, 17 on nodal metastasis, 5 patients on lung lesions, 4 patients on recurrence along the extrahepatic bile duct. After a median follow-up of 14 months median OS was 13.7 months, 1- and 2-year OS were 58% and 41%, respectively. Node and lung as metastatic sites were associated with a longer OS (p < 0.001). Median LC was 26.8 months, and intrahepatic cholangiocarcinoma was associated with longer LC (p = 0.036). Median DPFS was 11 months, with 1- and 2-year DPFS of 48% and 27.8%, respectively. Ten patients reported grade 1-2 toxicity and 2 cases of acute G3 biliary obstruction. CONCLUSIONS Stereotactic body radiotherapy (SBRT) is feasible in the context of mBTC. OS and PFS results are promising, considering that our patients were heavily pre-treated with systemic therapy. Patients with nodal or lung relapse have better prognosis. Distant relapses remain the main pattern of failure, but treatment of all metastatic sites seems to improve DMFS.
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21
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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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22
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Zhao X, Zhu X, Zhuang H, Guo X, Song Y, Ju X, Wang P, Yuan Z, Zhang H. Clinical efficacy of Stereotactic Body Radiation Therapy (SBRT) for adrenal gland metastases: A multi-center retrospective study from China. Sci Rep 2020; 10:7836. [PMID: 32398700 PMCID: PMC7217854 DOI: 10.1038/s41598-020-64770-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/24/2020] [Indexed: 11/23/2022] Open
Abstract
To evaluate the efficacy and safety of CyberKnife Stereotactic Body Radiation Therapy (SBRT) in the treatment of adrenal gland metastases (AGM), we designed a large-scale multicenter retrospective study to report the safety and efficacy of SBRT for inoperable AGM. In this study, 75 (61 males, 14 females) patients with 84 AGM and Karnofsky performance score ≥70 were treated by SBRT from October 2006 to January 2017. Of these, the purpose of treatment were controlling all known metastatic sites for 21 patients while 54 for palliation of bulky adrenal metastases. The efficacy and safety of SBRT were evaluated during follow-up. Potential factors predictive of local control (LC) and overall survival (OS) were identified by univariate and multivariate analysis. Median follow-up time was 12.7 months (range 1.8–96.4). The complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) rates were 23.8%, 23.8%, 31.0% and 21.4%, respectively. The 0.5, 1, and 2-year LC rates were 93.6%, 83.8%, and 62.1%, respectively; OS rates on the same follow-up intervals were 93.7%, 62.5%, and 49.6%, respectively, and the corresponding PFS rates were 48.5%, 33.9%, and 16.0%, respectively. The treatment was well tolerated with 2 patients reporting grade-3 diarrhea and fatigue, respectively. Multivariate analysis showed that simultaneous treatment of SBRT for other metastatic lesions, the number of AGM, initiation of systemic therapy, and the maximum diameter of AGM were predictive of LC rates. Moreover, patients with AGM < 5 cm had a superior OS compared with those with AGM ≥ 5 cm (28.0 months vs. 17.6 months, P = 0.032). SBRT is an effective therapeutic option for treatment of AGM with high LC rates with minimal toxicity.
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Affiliation(s)
- Xianzhi Zhao
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Xiaofei Zhu
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, 100191, China
| | - Xueling Guo
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yongchun Song
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Xiaoping Ju
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Ping Wang
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Zhiyong Yuan
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Huojun Zhang
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients. Radiat Oncol 2020; 15:30. [PMID: 32019553 PMCID: PMC7001286 DOI: 10.1186/s13014-020-1480-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Local ablative treatment strategies are frequently offered to patients diagnosed with oligometastatic disease. Stereotactic body radiotherapy (SBRT), as ablative treatment option, is well established for lung and liver metastases, whereas for isolated adrenal gland metastases the level of evidence is scarce. MATERIAL AND METHODS This single-institution analysis of oligometastatic or oligoprogressive disease was limited to patients who received SBRT to adrenal metastasis between 2012 and 2019. Patient, tumor, treatment characteristics, and dosimetric parameters were analyzed for evaluation of their effect on survival outcomes. RESULTS During the period of review 28 patients received ablative SBRT to their adrenal gland metastases. Most common primary tumors were non-small cell lung cancers (46%) with most patients diagnosed with a single adrenal gland metastasis (61%), which occurred after a median time of 14 months. SBRT was delivered to a median biological effective dose at α/β of 10 (BED10) of 75 Gy (range: 58-151 Gy). Median gross tumor volume (GTV) and median planning target volume (PTV) were 42 and 111 mL, respectively. The homogeneity and conformity indices were 1.17 (range: 1.04-1.64) and 0.5 (range: 0.4.0.99), respectively, with the conformity index being affected by dose restrictions to organs at risk (OARs) in 50% of the patients. Overall response rate based on RECIST criteria was 86% (CR = 29%, PR = 57%) with 2-year local control (LC) of 84.8%, 2-year progression-free survival (PFS) of 26.3%, and 1-and 2-year overall survival (OS) of 46.6 and 32.0%, respectively. During follow up, only two local recurrences occurred. A trend for superior LC was seen if BED10 was ≥75Gy (p = 0.101) or if the PTV was < 100 ml (p = 0.072). SBRT was tolerated well with only mild toxicity. CONCLUSION SBRT for adrenal metastases resulted in promising LC with low toxicity. Treatment response appeared to be superior, if SBRT was applied with higher BED. As the close proximity of OARs often limits the application of sufficiently high doses, further dose escalations strategies and techniques should be investigated in future.
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Stereotactic Body Radiation Therapy of Adrenal Metastases: A Pooled Meta-Analysis and Systematic Review of 39 Studies with 1006 Patients. Int J Radiat Oncol Biol Phys 2020; 107:48-61. [PMID: 32001383 DOI: 10.1016/j.ijrobp.2020.01.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To perform a systematic review and pooled meta-analysis of adrenal metastasis stereotactic body radiation therapy (SBRT) outcomes, treatment characteristics, and toxicity to define the efficacy and propose guidelines for intervention. METHODS AND MATERIALS We performed a comprehensive literature search of the Embase and PubMed databases of studies reporting outcome or toxicity data for photon-based SBRT of adrenal metastases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then conducted a meta-analysis to estimate pooled overall response, local control (LC), and overall survival and analyzed these outcomes in the context of dosimetric parameters and toxicity using metaregression. RESULTS Thirty-nine studies published between 2009 and 2019 reporting outcomes on 1006 patients were included. The median follow-up was 12 months, and the median biological equivalent dose (BED10, alpha/beta = 10) was 67 Gy. The pooled overall response was 54.6% (95% confidence interval [CI], 46.5%-62.5%). The pooled 1- and 2-year rates of LC were 82% (95% CI, 74%-88%) and 63% (95% CI, 50%-74%), respectively, and the pooled 1- and 2-year overall survival rates were 66% (95% CI, 57%-74%) and 42% (95% CI, 31%-53%), respectively. There was a strong positive association between SBRT dose and 1- and 2-year LC (P < .0001, P = .0002) and an association with 2-year OS (P = .03). Based on a metaregression of dose and LC, BED10 of 60 Gy, 80 Gy, and 100 Gy predicted 1-year LC of 70.5%, 84.8%, and 92.9% and 2-year LC of 47.8%, 70.1%, and 85.6%, respectively. The overall rate of grade 3 or higher toxicity was 1.8%. CONCLUSIONS SBRT of adrenal metastases provides good 1-year LC with an excellent safety profile, and dose escalation may be associated with improved LC. Prospective studies are needed to validate these findings and determine whether there are subsets of patients for whom adrenal metastasis-directed SBRT may confer a survival advantage.
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Scouarnec C, Pasquier D, Luu J, le Tinier F, Lebellec L, Rault E, Lartigau E, Mirabel X. Usefulness of Stereotactic Body Radiation Therapy for Treatment of Adrenal Gland Metastases. Front Oncol 2019; 9:732. [PMID: 31448234 PMCID: PMC6692476 DOI: 10.3389/fonc.2019.00732] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/22/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose: This study aimed to describe our institutional experience in the use of stereotactic body radiation therapy (SBRT) for the management of adrenal gland metastases from multiple primary cancers. Materials and Methods: We retrospectively reviewed 31 patients who underwent SBRT as treatment for 33 adrenal gland lesions in the academic radiotherapy department of Oscar Lambret cancer center between May 2011 and September 2018. The primary study endpoints were 1- and 2-year local control rates, defined as the absence of progression at the treatment site based on the response evaluation criteria in solid tumors (RECIST). Toxicities were graded in accordance with the Common Terminology Criteria for Adverse Events version 4.03. Results: The average tumor volume was 33.5 cm3 (standard deviation: 51.7 cm3), and the prescribed dose ranged from 30 to 55 Gy given in 3-9 fractions. The median biological effective dose was 112.5 Gy (range: 45-115.5 Gy), assuming α/β = 10. Considering progression at distant sites or death as competing events, the 1- and 2-year actuarial local control rates were 96.5% (95% confidence interval: 84.9-99.7) and 92.6% (95% confidence interval: 79.2-98.7), respectively. According to RECIST, a complete response was achieved in 10 (32.3%) lesions, a partial response in 10 (32.3%) lesions, and stability in 8 (25.8%) lesions. Three patients presented with local relapse at 8.8, 14, and 49.4 months. After a median follow-up of 18 months (range: 4.4-66.4), the median overall survival was 33.5 months (95% confidence interval: 17-not reached), while the median progression-free survival was 7.4 months (95% confidence interval: 3.8-14.1). Treatment-related toxicity was grade 1 or 2 in 42.4% of patients, including nausea (27.3%), abdominal pain (18.2%), vomiting (15.2%), and asthenia (9.1%). None of the patients developed acute grade ≥3 or late toxicity. Conclusion: SBRT seems to be a safe and effective treatment for adrenal gland metastases in patients whose primary tumor and metastatic spread are controlled by systemic treatment. With a 2-year local control rate of 92.6%, SBRT may be considered as one of the first-line treatments in oligometastatic patients with adrenal metastases.
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Affiliation(s)
- Cyrielle Scouarnec
- Academic Department of Radiation Oncology, Oscar Lambret Cancer Center, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Joel Luu
- Department of Biostatistics, Oscar Lambret Cancer Center, Lille, France
| | - Florence le Tinier
- Academic Department of Radiation Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Loïc Lebellec
- Department of Biostatistics, Oscar Lambret Cancer Center, Lille, France
| | - Erwann Rault
- Medical Physics Department - Academic Department of Radiation Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Eric Lartigau
- Academic Department of Radiation Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Xavier Mirabel
- Academic Department of Radiation Oncology, Oscar Lambret Cancer Center, Lille, France
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Katoh N, Onishi H, Uchinami Y, Inoue T, Kuriyama K, Nishioka K, Shimizu S, Komiyama T, Miyamoto N, Shirato H. Real-Time Tumor-Tracking Radiotherapy and General Stereotactic Body Radiotherapy for Adrenal Metastasis in Patients With Oligometastasis. Technol Cancer Res Treat 2019; 17:1533033818809983. [PMID: 30407123 PMCID: PMC6259059 DOI: 10.1177/1533033818809983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Precise local radiotherapy for adrenal metastasis can prolong the useful life of patients with oligometastasis. The aim of this retrospective, 2-center study was to establish the safety and effectiveness of real-time tumor-tracking radiotherapy and general stereotactic body radiotherapy in treating patients with adrenal metastatic tumors. Materials and Methods: Thirteen lesions in 12 patients were treated with real-time tumor-tracking radiotherapy (48 Gy in 8 fractions over 2 weeks) and 8 lesions in 8 patients were treated with general stereotactic body radiotherapy (40-50 Gy in 5-8 fractions over 2 weeks or 60-70 Gy in 10 fractions over 2 weeks). Overall survival rates, local control rates, and adverse effects were analyzed. Results: The actuarial overall survival rates for all patients at 1 and 2 years were 78.5% and 45.8%, respectively, with a median follow-up of 17.5 months, and the actuarial local control rates for all tumors at 1 and 2 years were 91.7% and 53.0%, respectively, with a median follow-up of 9 months. A complete local tumor response was obtained in 3 tumors treated by real-time tumor-tracking radiotherapy (lung adenocarcinomas with diameters of 35, 40, and 60 mm). There was a statistically significant difference in the local control between the groups treated by real-time tumor-tracking radiotherapy (100% at 1 year) and general stereotactic body radiotherapy (50% at 1 year; P < .001). No late adverse reactions at Grade 2 or higher were reported for either treatment group. Conclusions: This study showed that although both treatments are safe and effective, the real-time tumor-tracking radiotherapy is more effective than general stereotactic body radiotherapy in local control for adrenal metastasis.
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Affiliation(s)
- Norio Katoh
- 1 Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan.,2 Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Hiroshi Onishi
- 3 Department of Radiology, University of Yamanashi, Chuo, Japan
| | - Yusuke Uchinami
- 1 Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Tetsuya Inoue
- 1 Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan.,2 Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Kengo Kuriyama
- 3 Department of Radiology, University of Yamanashi, Chuo, Japan
| | - Kentaro Nishioka
- 4 Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Shinichi Shimizu
- 2 Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,4 Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | | | - Naoki Miyamoto
- 5 Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroki Shirato
- 2 Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,6 Department of Radiation Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
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27
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Short-term outcomes and clinical efficacy of stereotactic body radiation therapy (SBRT) in treatment of adrenal gland metastases from lung cancer. Radiat Oncol 2018; 13:205. [PMID: 30348187 PMCID: PMC6196411 DOI: 10.1186/s13014-018-1152-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/08/2018] [Indexed: 12/25/2022] Open
Abstract
Background To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) in the management of adrenal gland metastases (AGMs) from lung cancer. Moreover, it is the first two-institutional experience and the largest-to-date study to report the safety and efficacy of SBRT for inoperable AGM from lung cancer. Methods In this retrospective study, 30 patients (27 males, 3 females) with 32 AGMs were treated by SBRT from October 2006 to June 2016. Of these, 11 patients were treated with the intent of controlling all known metastatic sites and 19 for palliation of bulky AGMs. Follow-up was performed every 3 months for evaluations of efficacy and safety. Factors predictive of overall survival (OS) and local control (LC) were identified with univariate and then multivariate analysis. Results Median follow-up time was 10.7 months (2.9–96.4 months). The complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) rates were 23.3%, 33.3%, 33.3% and 16.7% respectively. The 6-month, 1, and 2-year LC rates were 96.9%, 96.9%, and 72.7% respectively. Additionally, the 6-month, 1, and 2-year OS rates were 85.6%, 58.1%, and 54.0% respectively while 6-month, 1, and 2-year progression free survival (PFS) rates were 39.5%, 24.6%, and 8.2%, respectively. All the patients with cancer-induced pain (8 with abdominal pain and 6 with lumbar back pain) had significant alleviations after SBRT. The treatment was well tolerated with only 1 patient reporting grade-3 diarrhoea. No predictors of OS and LC were found after multivariate analysis, while it was demonstrated that biologic equivalent dose (BED10, α/β = 10) ≥85.5Gy (P = 0.007) and gross tumor volume < 30 ml (P = 0.003) correlated with LC only after univariate analysis. Conclusion SBRT is a safe and effective treatment modality in the management of AGMs from lung cancer with high LC rates and acceptable toxicity.
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Palacios MA, Bohoudi O, Bruynzeel AME, van Sörsen de Koste JR, Cobussen P, Slotman BJ, Lagerwaard FJ, Senan S. Role of Daily Plan Adaptation in MR-Guided Stereotactic Ablative Radiation Therapy for Adrenal Metastases. Int J Radiat Oncol Biol Phys 2018; 102:426-433. [PMID: 29902559 DOI: 10.1016/j.ijrobp.2018.06.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/08/2018] [Accepted: 06/01/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE To study interfractional organ changes during magnetic resonance (MR)-guided stereotactic ablative radiation therapy for adrenal metastases and to evaluate the dosimetric advantages of online plan adaptation. METHODS AND MATERIALS Seventeen patients underwent a total of 84 fractions of video-assisted, respiration-gated, MR-guided adaptive radiation therapy to deliver either 50 Gy (5 fractions), 60 Gy (8 fractions), or 24 Gy (3 fractions). An MR scan was repeated before each fraction, followed by rigid coregistration to the gross tumor volume (GTV) on the pretreatment MR scan. Contour deformation, planning target volume (PTV) (GTV + 3 mm) expansion, and online plan reoptimization were then performed. Reoptimized plans were compared with baseline treatment plans recalculated on the anatomy-of-the-day ("predicted plans"). Interfractional changes in organs at risk (OARs) were quantified according to OAR volume changes within a 3 cm distance from the PTV surface, center of mass displacements, and the Dice similarity coefficient. Plan quality evaluation was based on target coverage (GTV and PTV) and high dose sparing of all OARs (V36Gy, V33Gy, and V25Gy). RESULTS Substantial center of mass displacements were observed for stomach, bowel, and duodenum, 17, 27 and 36 mm, respectively. Maximum volume changes for the stomach, bowel, and duodenum within 3 cm of PTV were 23.8, 20.5, and 20.9 cm3, respectively. Dice similarity coefficient values for OARs ranged from 0.0 to 0.9 for all fractions. Baseline plans recalculated on anatomy-of-the-day revealed underdosage of target volumes and variable OAR sparing, leading to a failure to meet institutional constraints in a third of fractions. Online reoptimization improved target coverage in 63% of fractions and reduced the number of fractions not meeting the V95% objective for GTV and PTV. Reoptimized plans exhibited significantly better sparing of OARs. CONCLUSIONS Significant interfractional changes in OAR positions were observed despite breath-hold stereotactic ablative radiation therapy delivery under MR-guidance. Online reoptimization of treatment plans led to significant improvements in target coverage and OAR sparing.
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Affiliation(s)
- Miguel A Palacios
- Department of Radiation Oncology, VU Medical Centre, Amsterdam, The Netherlands.
| | - Omar Bohoudi
- Department of Radiation Oncology, VU Medical Centre, Amsterdam, The Netherlands
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, VU Medical Centre, Amsterdam, The Netherlands
| | | | - Paul Cobussen
- Department of Radiation Oncology, VU Medical Centre, Amsterdam, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU Medical Centre, Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, VU Medical Centre, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU Medical Centre, Amsterdam, The Netherlands
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29
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Toesca DAS, Koong AJ, von Eyben R, Koong AC, Chang DT. Stereotactic body radiation therapy for adrenal gland metastases: Outcomes and toxicity. Adv Radiat Oncol 2018; 3:621-629. [PMID: 30370363 PMCID: PMC6200881 DOI: 10.1016/j.adro.2018.05.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose This study aimed to report on our institutional experience in the use of stereotactic body radiation therapy (SBRT) for the treatment of adrenal gland metastases. Specifically, we examined the outcomes and toxicity from this treatment modality on adjacent organs at risk. Methods and Materials Data were retrieved from patients with adrenal metastases who were treated with SBRT between 2008 and 2017. Patients with primary adrenal malignancies were excluded. Toxicities were graded in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Time-to-event rates were calculated from the date of SBRT delivery. Results In total, 35 patients with adrenal metastases were identified. Four patients were treated for bilateral disease. The median dose was 40 Gy (range, 20-54 Gy) in 5 fractions (range, 1-6 fractions). The median follow-up time was 37 months (range, 14-451 months) from disease diagnosis and 7 months (range, 1-54 months) from the SBRT start date. With death treated as a competing risk event, the cumulative incidence of local failure was 7.6% at 1 year after SBRT and 19.2% at 3 years. The median overall survival (OS) time was 19 months (95% confidence interval, 8-54 months) and tumor size correlated with survival (P = .0006). Patients with metastases <2.9 cm had a median OS of 54 months compared with 11 months for those with adrenal metastases ≥2.9 cm (P = .01). Incidence of grade 2 toxicity was 17% with no case of grade ≥3 toxicity. SBRT did not impact renal function with a mean estimated decline in glomerular filtration rate of only 2.6 ± 8 mL/min/1.73 m2 compared with baseline. Combined kidneys V5 and combined renal cortex V17.5 did not correlate with a change in estimated glomerular filtration rate (P = .7 and P = .9, respectively). Conclusions SBRT offers excellent local control for the treatment of adrenal gland metastases with very low toxicity rates and no significant short-term impact on renal function.
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Affiliation(s)
- Diego A S Toesca
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Amanda J Koong
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
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30
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Franzese C, Fogliata A, Comito T, Tozzi A, Iftode C, Clerici E, Franceschini D, Navarria P, Ascolese AM, Di Brina L, De Rose F, D'Agostino GR, Cozzi L, Scorsetti M. Stereotactic/hypofractionated body radiation therapy as an effective treatment for lymph node metastases from colorectal cancer: an institutional retrospective analysis. Br J Radiol 2017; 90:20170422. [PMID: 28869396 DOI: 10.1259/bjr.20170422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The colorectal cancer (CRC) might present loco-regional recurrence, including lymph-node metastasis. Stereotactic body radiotherapy (SBRT) is a non-invasive and well-tolerated ablative treatment. Aim of the present study is to evaluate efficacy and toxicity of SBRT with volumetric modulated arc therapy (VMAT) in this setting. METHODS 35 patients presenting a total of 47 nodal recurrences from CRC, treated with VMAT-SBRT from 2008 to 2015, were selected. About three fourth of the treatments delivered 45 Gy in 6 daily fractions. End-points were the detection of toxicities, overall survival (OS), local control (LC), disease progression free incidence (DPFI) and disease free survival (DFS). Tumour response was assessed according to the RECIST criteria. RESULTS Only Grade 1 and 2 toxicities were recorded. Median follow-up was 15 months (range 2-68). Local relapse was reported in 6 patients, regional relapse in 10 patients. Complete remission was reported in 20 cases (53%), partial remission in 14 (37%). Rates of LC at 1, 2 and 3 years were 85.3, 75.0 and 75.0%, respectively. At 1 year the actuarial OS was 100%, at 2 and 3 years was 81.4%. Median DFS was estimated in 16 months, with an incidence of 69.4, 33.3 and 19.4% at 1, 2 and 3 years, respectively. CONCLUSION The use of the VMAT-SBRT in lymph-node recurrence of CRC could prevent severe complications and achieve satisfying rates of disease control. Advances in knowledge: The use of VMAT-SBRT is a viable approach for lymph-node recurrence of CRC.
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Affiliation(s)
- Ciro Franzese
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Antonella Fogliata
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Tiziana Comito
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Angelo Tozzi
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Cristina Iftode
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Elena Clerici
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Davide Franceschini
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Pierina Navarria
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Anna Maria Ascolese
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Lucia Di Brina
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Fiorenza De Rose
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Giuseppe R D'Agostino
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Luca Cozzi
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy.,2 Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| | - Marta Scorsetti
- 1 Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy.,2 Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
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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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