Felix Ehret1,2,3, David Kaul4,5,6, Markus Kufeld7, Clara Vom Endt4, Volker Budach4,5, Carolin Senger4,5, Christoph Fürweger7,8, Alfred Haidenberger7, Alexander Muacevic7. 1. Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany. felix.ehret@charite.de. 2. Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany. felix.ehret@charite.de. 3. European Radiosurgery Center, 81377, Munich, Germany. felix.ehret@charite.de. 4. Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany. 5. Charité CyberKnife Center, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany. 6. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Berlin, 69120, Heidelberg, Germany. 7. European Radiosurgery Center, 81377, Munich, Germany. 8. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, 50937, Cologne, Germany.
Abstract
PURPOSE: Adrenal gland metastases (AGMs) are a common manifestation of metastatic tumor spread, especially in non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In patients with a limited systemic tumor burden, effective treatments for AGMs are needed. Due to varying fractionation schemes and limited reports, short-course treatment results for stereotactic body radiotherapy (SBRT) for AGMs are lacking. This work analyzes the outcomes of short-course SBRT for AGMs. METHODS: Patients who underwent robotic SBRT for AGMs with one to five fractions were eligible for analysis. RESULTS: In total, data from 55 patients with 72 AGMs from two institutions were analyzed. Most AGMs originated from renal cell carcinoma (38%) and NSCLC (35%). The median follow-up was 16.4 months. The median prescription dose and isodose line were 24 Gy and 70%, respectively. Most patients (85%) received SBRT with just one fraction. The median biologically effective dose assuming an α/β ratio of 10 (BED10) was 80.4 Gy. The local control and progression-free survival after 1 and 2 years were 92.9%, 67.8%, and 46.2%, as well as 24.3%, respectively. Thirteen patients (24%) suffered from grade 1 or 2 toxicities. The BED10 showed a significant impact on LC (p < 0.01). Treatments with a BED10 equal to or above the median were associated with a better LC (p < 0.01). CONCLUSION: Robotic SBRT is an efficient and safe treatment modality for AGM. Treatment-associated side effects are sporadic and manageable. Results suggest short-course SBRT to be a preferable and time-saving treatment option for the management of AGMs if an adequate BED10 can be safely applied.
PURPOSE: Adrenal gland metastases (AGMs) are a common manifestation of metastatic tumor spread, especially in non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In patients with a limited systemic tumor burden, effective treatments for AGMs are needed. Due to varying fractionation schemes and limited reports, short-course treatment results for stereotactic body radiotherapy (SBRT) for AGMs are lacking. This work analyzes the outcomes of short-course SBRT for AGMs. METHODS: Patients who underwent robotic SBRT for AGMs with one to five fractions were eligible for analysis. RESULTS: In total, data from 55 patients with 72 AGMs from two institutions were analyzed. Most AGMs originated from renal cell carcinoma (38%) and NSCLC (35%). The median follow-up was 16.4 months. The median prescription dose and isodose line were 24 Gy and 70%, respectively. Most patients (85%) received SBRT with just one fraction. The median biologically effective dose assuming an α/β ratio of 10 (BED10) was 80.4 Gy. The local control and progression-free survival after 1 and 2 years were 92.9%, 67.8%, and 46.2%, as well as 24.3%, respectively. Thirteen patients (24%) suffered from grade 1 or 2 toxicities. The BED10 showed a significant impact on LC (p < 0.01). Treatments with a BED10 equal to or above the median were associated with a better LC (p < 0.01). CONCLUSION: Robotic SBRT is an efficient and safe treatment modality for AGM. Treatment-associated side effects are sporadic and manageable. Results suggest short-course SBRT to be a preferable and time-saving treatment option for the management of AGMs if an adequate BED10 can be safely applied.
Authors: William C Chen; Joe D Baal; Ulysis Baal; Jonathan Pai; Alexander Gottschalk; Lauren Boreta; Steve E Braunstein; David R Raleigh Journal: Int J Radiat Oncol Biol Phys Date: 2020-01-27 Impact factor: 7.038
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