Stereotactic Radiation Therapy for Adrenal Metastases

Purpose/Objective(s)The adrenal gland is a common site of metastasis in lung and other cancers. Surgical resection, radiofrequency ablation and chemoembolization are used to treat these metastases. Stereotactic body radiation therapy (SBRT) is being investigated as a non-invasive alternative for the treatment of these lesions. We present our experience of using SBRT for the treatment of adrenal metastases.Materials/MethodsWe conducted an IRB approved, retrospective review of patients with adrenal metastases treated with SBRT. Treatment details were reviewed and tumor response was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) at time of first post-SBRT CT scan and also for any subsequent CT scans obtained at follow-up. Best tumor response was defined as the greatest percent tumor reduction or least amount of disease progression noted on any post-SBRT CT.ResultsTwenty-five patients were identified with 30 metastatic adrenal lesions treated with SBRT between the years 2001 and 2012; median age at treatment was 60.4 years (range, 25.8-85 years). Primary diagnoses include NSCLC (15 patients, 19 lesions), small cell lung cancer (1 patient), hepatocellular carcinoma (3 patients) and other (6 patients). Five patients had solitary adrenal metastases at time of SBRT. Twelve lesions received a single fraction - median dose 18 Gy (range, 14-18 Gy). Eighteen lesions were treated with multiple fractions with median dose of 32 Gy (range, 16-40 Gy) and median dose/fraction of 7 Gy (range, 3-8 Gy). The median GTV was 70.97 cc (range, 0.69 - 984.54 cc) and median PTV was 72.8 cc (range, 3.21-984.54 cc). Median follow-up for first post-SBRT CT (n = 22 lesions) was 1.6 months (range, 0.87-5.37 months) and for CT showing best tumor response post-SBRT (n = 14 lesions) was 4.7 months (range, 0.9-44.8 months). Tumor response is presented in the Table. No grade 3 or 4 acute toxicities were noted; 1 patient experienced duodenal perforation due to ulcer 14 months after treatment with 18 Gy in 1 fraction. At time of analysis 16 patients are deceased with median survival after SBRT of 4.8 months (range, 0.4-26.5 months); 5 patients are alive with median survival after SBRT of 33.1 months (range, 2-42.3 months). One patient with NSCLC was treated to the left adrenal lesion thrice in 4 years; he is living 42 months after first course of SBRT.ConclusionsPoster Viewing Abstract 2369; TableTumor responseAll lesionsNSCLC lesionsSingle fraction SBRT lesionsMultiple fraction SBRT lesionMedian percent tumor response at first post-SBRT CT (%)7.6 (−34.5-100)8.7 (−34.5-100)8.7 (−26.3-23)7.7 (−34.5-100)Complete or partial response (CR or PR)2 (1 CR, 1 PR) (9%)2 (1 CR, 1 PR) (13%)02 (1 CR, 1 PR) (13.3%)Stable disease (SD)17 (77%)12 (80%)6 (86%)11 (73.3%)Progressive disease (PD)3 (14%)1 (7%)1 (14%)2 (13.3%)-----Median best tumor response (%)27.6 (−34.5-100)20.3 (−34.5-100)30.9 (−11.7-100)27.6 (−34.5-100)CR or PR6 (2 CR, 4 PR) (43%)4 (2 CR, 2 PR) (40%)2 (1 CR, 1 PR) (50%)4 (1 CR, 3 PR) (40%)SD7 (50%)5 (50%)2 (50%)5 (50%)PD1 (7%)1 (10%)01 (10%) Open table in a new tab Purpose/Objective(s)The adrenal gland is a common site of metastasis in lung and other cancers. Surgical resection, radiofrequency ablation and chemoembolization are used to treat these metastases. Stereotactic body radiation therapy (SBRT) is being investigated as a non-invasive alternative for the treatment of these lesions. We present our experience of using SBRT for the treatment of adrenal metastases. The adrenal gland is a common site of metastasis in lung and other cancers. Surgical resection, radiofrequency ablation and chemoembolization are used to treat these metastases. Stereotactic body radiation therapy (SBRT) is being investigated as a non-invasive alternative for the treatment of these lesions. We present our experience of using SBRT for the treatment of adrenal metastases. Materials/MethodsWe conducted an IRB approved, retrospective review of patients with adrenal metastases treated with SBRT. Treatment details were reviewed and tumor response was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) at time of first post-SBRT CT scan and also for any subsequent CT scans obtained at follow-up. Best tumor response was defined as the greatest percent tumor reduction or least amount of disease progression noted on any post-SBRT CT. We conducted an IRB approved, retrospective review of patients with adrenal metastases treated with SBRT. Treatment details were reviewed and tumor response was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) at time of first post-SBRT CT scan and also for any subsequent CT scans obtained at follow-up. Best tumor response was defined as the greatest percent tumor reduction or least amount of disease progression noted on any post-SBRT CT. ResultsTwenty-five patients were identified with 30 metastatic adrenal lesions treated with SBRT between the years 2001 and 2012; median age at treatment was 60.4 years (range, 25.8-85 years). Primary diagnoses include NSCLC (15 patients, 19 lesions), small cell lung cancer (1 patient), hepatocellular carcinoma (3 patients) and other (6 patients). Five patients had solitary adrenal metastases at time of SBRT. Twelve lesions received a single fraction - median dose 18 Gy (range, 14-18 Gy). Eighteen lesions were treated with multiple fractions with median dose of 32 Gy (range, 16-40 Gy) and median dose/fraction of 7 Gy (range, 3-8 Gy). The median GTV was 70.97 cc (range, 0.69 - 984.54 cc) and median PTV was 72.8 cc (range, 3.21-984.54 cc). Median follow-up for first post-SBRT CT (n = 22 lesions) was 1.6 months (range, 0.87-5.37 months) and for CT showing best tumor response post-SBRT (n = 14 lesions) was 4.7 months (range, 0.9-44.8 months). Tumor response is presented in the Table. No grade 3 or 4 acute toxicities were noted; 1 patient experienced duodenal perforation due to ulcer 14 months after treatment with 18 Gy in 1 fraction. At time of analysis 16 patients are deceased with median survival after SBRT of 4.8 months (range, 0.4-26.5 months); 5 patients are alive with median survival after SBRT of 33.1 months (range, 2-42.3 months). One patient with NSCLC was treated to the left adrenal lesion thrice in 4 years; he is living 42 months after first course of SBRT. Twenty-five patients were identified with 30 metastatic adrenal lesions treated with SBRT between the years 2001 and 2012; median age at treatment was 60.4 years (range, 25.8-85 years). Primary diagnoses include NSCLC (15 patients, 19 lesions), small cell lung cancer (1 patient), hepatocellular carcinoma (3 patients) and other (6 patients). Five patients had solitary adrenal metastases at time of SBRT. Twelve lesions received a single fraction - median dose 18 Gy (range, 14-18 Gy). Eighteen lesions were treated with multiple fractions with median dose of 32 Gy (range, 16-40 Gy) and median dose/fraction of 7 Gy (range, 3-8 Gy). The median GTV was 70.97 cc (range, 0.69 - 984.54 cc) and median PTV was 72.8 cc (range, 3.21-984.54 cc). Median follow-up for first post-SBRT CT (n = 22 lesions) was 1.6 months (range, 0.87-5.37 months) and for CT showing best tumor response post-SBRT (n = 14 lesions) was 4.7 months (range, 0.9-44.8 months). Tumor response is presented in the Table. No grade 3 or 4 acute toxicities were noted; 1 patient experienced duodenal perforation due to ulcer 14 months after treatment with 18 Gy in 1 fraction. At time of analysis 16 patients are deceased with median survival after SBRT of 4.8 months (range, 0.4-26.5 months); 5 patients are alive with median survival after SBRT of 33.1 months (range, 2-42.3 months). One patient with NSCLC was treated to the left adrenal lesion thrice in 4 years; he is living 42 months after first course of SBRT. ConclusionsPoster Viewing Abstract 2369; TableTumor responseAll lesionsNSCLC lesionsSingle fraction SBRT lesionsMultiple fraction SBRT lesionMedian percent tumor response at first post-SBRT CT (%)7.6 (−34.5-100)8.7 (−34.5-100)8.7 (−26.3-23)7.7 (−34.5-100)Complete or partial response (CR or PR)2 (1 CR, 1 PR) (9%)2 (1 CR, 1 PR) (13%)02 (1 CR, 1 PR) (13.3%)Stable disease (SD)17 (77%)12 (80%)6 (86%)11 (73.3%)Progressive disease (PD)3 (14%)1 (7%)1 (14%)2 (13.3%)-----Median best tumor response (%)27.6 (−34.5-100)20.3 (−34.5-100)30.9 (−11.7-100)27.6 (−34.5-100)CR or PR6 (2 CR, 4 PR) (43%)4 (2 CR, 2 PR) (40%)2 (1 CR, 1 PR) (50%)4 (1 CR, 3 PR) (40%)SD7 (50%)5 (50%)2 (50%)5 (50%)PD1 (7%)1 (10%)01 (10%) Open table in a new tab