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Radioablation of adrenal gland malignomas with interstitial high-dose-rate brachytherapy

Efficacy and outcome

Radioablation von Nebennierenmalignomen mit interstitieller High-dose-rate-Brachytherapie

Wirkung und Outcome

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Abstract

Purpose

To assess the efficacy, safety, and outcome of image-guided high-dose-rate (HDR) brachytherapy in patients with adrenal gland metastases (AGM).

Materials and methods

From January 2007 to April 2014, 37 patients (7 female, 30 male; mean age 66.8 years, range 41.5–82.5 years) with AGM from different primary tumors were treated with CT-guided HDR interstitial brachytherapy (iBT). Primary endpoint was local tumor control (LTC). Secondary endpoints were time to untreatable progression (TTUP), time to progression (TTP), overall survival (OS), and safety. In a secondary analysis, risk factors with an influence on survival were identified.

Results

The median biological equivalent dose (BED) was 37.4 Gy. Mean LTC after 12 months was 88%; after 24 months this was 74%. According to CTCAE criteria, one grade 3 adverse event occurred. Median OS after first diagnosis of AGM was 18.3 months. Median OS, TTUP, and TTP after iBT treatment were 11.4, 6.6, and 3.5 months, respectively. Uni- and multivariate Cox regression analyses revealed significant influences of synchronous disease, tumor diameter, and the total number of lesions on OS or TTUP or both.

Conclusion

Image-guided HDR-iBT is safe and effective. Treatment- and primary tumor-independent features influenced survival of patients with AGM after HDR-iBR treatment.

Zusammenfassung

Zielsetzung

Beurteilung der Effektivität, Sicherheit und Ergebnisse nach bildgeführter High-dose-rate-(HDR-)Brachytherapie bei Patienten mit Nebennierenmetastasen.

Material und Methoden

Von Januar 2007 bis April 2014 wurden 37 Patienten (7 weiblich, 30 männlich; mittleres Alter 66,8 Jahre, Spanne 41,5–82,5 Jahre) mit Nebennierenmetastasen verschiedener Primarien mit CT-gesteuerter interstitieller HDR-Brachytherapie (iBT) behandelt. Der primäre Endpunkt war die lokale Tumorkontrolle (LTC). Sekundäre Endpunkte umfassten die Zeit bis zum nicht mehr behandelbaren Progress (TTUP), die Zeit bis zum Progress (TTP), das Gesamtüberleben (OS) und die Sicherheit der Methode. In einer sekundären Analyse wurden Risikofaktoren ermittelt, die Einfluss auf das Überleben hatten.

Ergebnisse

Die mediane biologische Äquivalenzdosis (BED) lag bei 37,4 Gy. Die mittlere LTC betrug nach 12 Monaten 88 % und nach 24 Monaten 74 %. Nach CTCAE-Kriterien trat ein Grad-3-Event auf. Das mediane OS nach Erstdiagnose der Nebennierenmetastasen ergab 18,3 Monate. Das mediane OS, TTUP und TTP nach CT-gesteuerter iBT betrug jeweils 11,4, 6,6 und 3,5 Monate. Uni- und multivariate Cox-Regressionsanalysen zeigten einen signifikanten Einfluss synchroner Nebennierenmetastasen, des Tumordurchmessers und der Gesamtanzahl neoplastischer Läsionen auf OS und/oder TTUP.

Schlussfolgerung

Die bildgeführte HDR-iBT von Nebennierenmetastasen ist sicher und effektiv. Behandlungs- und primariusunabhängige Kofaktoren beeinflussten das Überleben von Patienten mit Nebennierenmetastasen nach der Behandlung mit HDR-iBR.

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Funding

This work was funded exclusively by the University of Magdeburg.

Author information

Authors and Affiliations

  1. Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany

    K. Mohnike, K. Neumann, M. Seidensticker, R. Seidensticker, M. Pech, T. Streitparth & J. Ricke

  2. Klinik für Strahlentherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany

    P. Hass & G. Gademann

  3. Klinik für Nieren- und Hochdruckkrankheiten, Diabetologie und Endokrinologie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany

    S. Klose

  4. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany

    B. Garlipp & C. Benckert

  5. Klinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany

    J. J. Wendler, U. B. Liehr & M. Schostak

  6. Klinik für Dermatologie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany

    D. Göppner

  7. DTZ am Frankfurter Tor, Kadiner Str.23, 10243, Berlin, Germany

    K. Mohnike

Authors
  1. K. Mohnike
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  2. K. Neumann
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  3. P. Hass
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  4. M. Seidensticker
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  6. M. Pech
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  9. B. Garlipp
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  12. U. B. Liehr
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  14. D. Göppner
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  15. G. Gademann
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  16. J. Ricke
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Corresponding author

Correspondence to K. Mohnike.

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Conflict of interest

K. Mohnike, K. Neumann, P. Hass, M. Seidensticker, R. Seidensticker, M. Pech, S. Klose, T. Streitparth, B. Garlipp, C. Benckert, J.J. Wendler, U.B. Liehr, M. Schostak, D. Göppner, G. Gademann, and J. Ricke declare that they have no competing interests.

Ethical standards

The study was conducted in accordance with the protocol and with the ethical principles that have their origin in the Declaration of Helsinki and ICH-GCP.

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Mohnike, K., Neumann, K., Hass, P. et al. Radioablation of adrenal gland malignomas with interstitial high-dose-rate brachytherapy. Strahlenther Onkol 193, 612–619 (2017). https://doi.org/10.1007/s00066-017-1120-2

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  • DOI: https://doi.org/10.1007/s00066-017-1120-2

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