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Adrenal SBRT: a multi-institutional review of treatment outcomes and toxicity

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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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Data availability

The IRB approval for this study did not include data sharing; therefore, data from this study will not be shared publicly.

Abbreviations

BED:

Biologic effective dose

CI:

Confidence interval

CT:

Computed tomography

CTCAE:

Common terminology for adverse events

GI:

Gastrointestinal

GTV:

Gross tumor volume

Gy:

Gray

IMRT:

Intensity modulated radiotherapy

IQR:

Interquartile range

ITV:

Internal target volume

NSAID:

Non-steroidal anti-inflammatory drug

NSCLC:

Non-small cell lung cancer

PTV:

Planning tumor volume

SBRT:

Stereotactic body radiotherapy

VMAT:

Volumetric modulated arc therapy

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Funding

This work was not supported by any grants or other financial or material support.

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Author notes

  1. Emily C. Daugherty and Michael K. Farris share senior authorship.

Authors and Affiliations

  1. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Corbin A. Helis, Ryan T. Hughes, Karina Nieto & Michael K. Farris

  2. Department of Radiation Oncology, University of Cincinnati Cancer Institute, Cincinnati, OH, 45219, USA

    Adannia Ufondu & Emily C. Daugherty

Authors
  1. Corbin A. Helis
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  2. Ryan T. Hughes
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Correspondence to Corbin A. Helis.

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The authors declare that they have no conflict of interest. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

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IRB approval was obtained by both institutions.

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Helis, C.A., Hughes, R.T., Nieto, K. et al. Adrenal SBRT: a multi-institutional review of treatment outcomes and toxicity. Clin Exp Metastasis 37, 585–592 (2020). https://doi.org/10.1007/s10585-020-10052-0

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  • DOI: https://doi.org/10.1007/s10585-020-10052-0

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