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01-12-2020 | Metastasis | Research

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

Authors: Laila König, Matthias F. Häfner, Sonja Katayama, Stefan A. Koerber, Eric Tonndorf-Martini, Denise Bernhardt, Bastian von Nettelbladt, Fabian Weykamp, Philipp Hoegen, Sebastian Klüter, Matthew S. Susko, Jürgen Debus, Juliane Hörner-Rieber

Published in: Radiation Oncology | Issue 1/2020

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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Title: Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients
Authors: Laila König
Matthias F. Häfner
Sonja Katayama
Stefan A. Koerber
Eric Tonndorf-Martini
Denise Bernhardt
Bastian von Nettelbladt
Fabian Weykamp
Philipp Hoegen
Sebastian Klüter
Matthew S. Susko
Jürgen Debus
Juliane Hörner-Rieber
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Metastasis
Radiotherapy
Published in: Radiation Oncology / Issue 1/2020
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-020-1480-0

At a glance: The STEP trials

Springer Medicine

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

Abstract

Introduction

Material and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Material and methods

Results

Conclusion

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