Stereotactic Body Radiotherapy for Adrenal Oligometastasis in Lung Cancer Patients

Overview

Journal Br J Radiol

Publisher Oxford University Press

Specialty Radiology

Date 2020 Aug 22

PMID 32822540

Citations 10

Authors

Fabio Arcidiacono

Cynthia Aristei

Alessandro Marchionni

Marco Italiani

Cristian Paolo Luca Fulcheri

Simonetta Saldi

Michelina Casale

Gianluca Ingrosso

Paola Anselmo

Ernesto Maranzano

Affiliations

Soon will be listed here.

Abstract

Objective: To report our experience on stereotactic body radiotherapy (SBRT) in adrenal metastases from lung cancer.

Methods: 37 oligometastatic lung cancer patients with 38 adrenal metastases submitted to SBRT were retrospectively analyzed. SBRT was delivered by volumetric modulated arc therapy (VMAT) or helical tomotherapy (HT). Primary study end point was local recurrence-free survival (LR-FS) and secondary end points were distant-progression free survival (d-PFS) and overall survival (OS).

Results: Median age was 67 years and primary tumor was non-small-cell lung cancer in 27 (73%) and small-cell lung cancer in 10 (27%) patients. Adrenal metastases were in the left side in 66% cases. Median prescribed dose was 30 Gy in 5 fractions for a median biologically equivalent dose (α/β ratio 10 Gy, BED10) of 48 Gy. Most patients (62%) were submitted to SBRT alone, while the others (38%) received chemo-, immune- or target- therapies. Median follow-up was 10.5 months, median OS 16 months and median d-PFS 3 months. 27 (70%) patients obtained a local control with a median LR-FS of 32 months. LR-FS was significantly related to BED10 with a better LC with BED10 ≥72 Gy, 1- and 2 year LR-FS rates were 54.1±11.6% and 45±12.7% 100 and 100% for BED ≤59.5 Gy and BED ≥72 Gy, respectively ( = 0.05). There was no severe toxicity.

Conclusion: SBRT was effective and safe in lung cancer adrenal metastases. A dose-response relationship was found between BED10 72 Gy and better local control. No significant toxicity was registered thanks to the respect of dose constraints and suspension of chemo- and target-therapies.

Advances In Knowledge: SBRT with a BED10 72 Gy is an effective treatment for adrenal oligometastatic lung cancer patients.

Citing Articles

Retrospective Analysis of Efficacy and Toxicity of Stereotactic Body Radiotherapy and Surgical Resection of Adrenal Metastases from Solid Tumors.

Lutscher J, Gelpke H, Zehnder A, Mauti L, Padevit C, John H Cancers (Basel). 2024; 16(15).

PMID: 39123383 PMC: 11311624. DOI: 10.3390/cancers16152655.

Stereotactic Body Radiotherapy: is less fractionation more effective in adrenal and renal malignant lesions?.

Rivas D, de la Torre-Luque A, Moreno-Olmedo E, Moreno P, Suarez V, Serradilla A World J Urol. 2024; 42(1):435.

PMID: 39046532 PMC: 11269452. DOI: 10.1007/s00345-024-05140-9.

Lower fluorodeoxyglucose positron emission tomography maximum standardized uptake value may show a better response to stereotactic body radiotherapy of adrenals in oligometastatic disease.

Zhelev K, Mihaylova-Hristov M, Conev N, Cholakova M, Korabova B, Petrov I Contemp Oncol (Pozn). 2024; 27(4):263-268.

PMID: 38405207 PMC: 10883199. DOI: 10.5114/wo.2023.135288.

Risk factors of local control in adrenal metastases treated by stereotactic body radiation therapy - a systematic review and meta-analysis.

Liao X, Kishi K, Du K, Komaki R, Mizoe J, Aikawa G Front Oncol. 2023; 13:1193574.

PMID: 38045003 PMC: 10691549. DOI: 10.3389/fonc.2023.1193574.

International consensus on radiotherapy in metastatic non-small cell lung cancer.

Zhu Z, Ni J, Cai X, Su S, Zhuang H, Yang Z Transl Lung Cancer Res. 2022; 11(9):1763-1795.

PMID: 36248338 PMC: 9554677. DOI: 10.21037/tlcr-22-644.

References

Park C, Papiez L, Zhang S, Story M, Timmerman R . Universal survival curve and single fraction equivalent dose: useful tools in understanding potency of ablative radiotherapy. Int J Radiat Oncol Biol Phys. 2008; 70(3):847-52. DOI: 10.1016/j.ijrobp.2007.10.059. View

Arbour K, Riely G . Systemic Therapy for Locally Advanced and Metastatic Non-Small Cell Lung Cancer: A Review. JAMA. 2019; 322(8):764-774. DOI: 10.1001/jama.2019.11058. View

Slotman B, van Tinteren H, Praag J, Knegjens J, El Sharouni S, Hatton M . Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet. 2014; 385(9962):36-42. DOI: 10.1016/S0140-6736(14)61085-0. View

Tanvetyanon T, Robinson L, Schell M, Strong V, Kapoor R, Coit D . Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: a systematic review and pooled analysis. J Clin Oncol. 2008; 26(7):1142-7. DOI: 10.1200/JCO.2007.14.2091. View

Ricardi U, Badellino S, Filippi A . Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach. J Radiat Res. 2016; 57(S1):i58-i68. PMC: 4990103. DOI: 10.1093/jrr/rrw006. View

Holy R, Piroth M, Pinkawa M, Eble M . Stereotactic body radiation therapy (SBRT) for treatment of adrenal gland metastases from non-small cell lung cancer. Strahlenther Onkol. 2011; 187(4):245-51. DOI: 10.1007/s00066-011-2192-z. View

Celik E, Semrau R, Baues C, Trommer-Nestler M, Baus W, Marnitz S . Robot-assisted Extracranial Stereotactic Radiotherapy of Adrenal Metastases in Oligometastatic Non-small Cell Lung Cancer. Anticancer Res. 2017; 37(9):5285-5291. DOI: 10.21873/anticanres.11954. View

Chen W, Baal J, Baal U, Pai J, Gottschalk A, Boreta L . Stereotactic Body Radiation Therapy of Adrenal Metastases: A Pooled Meta-Analysis and Systematic Review of 39 Studies with 1006 Patients. Int J Radiat Oncol Biol Phys. 2020; 107(1):48-61. PMC: 8177042. DOI: 10.1016/j.ijrobp.2020.01.017. View

Campo M, Al-Halabi H, Khandekar M, Shaw A, Sequist L, Willers H . Integration of Stereotactic Body Radiation Therapy With Tyrosine Kinase Inhibitors in Stage IV Oncogene-Driven Lung Cancer. Oncologist. 2016; 21(8):964-73. PMC: 4978553. DOI: 10.1634/theoncologist.2015-0508. View

10.

Lam K, Lo C . Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol (Oxf). 2002; 56(1):95-101. DOI: 10.1046/j.0300-0664.2001.01435.x. View

11.

Franzese C, Franceschini D, Cozzi L, DAgostino G, Comito T, De Rose F . Minimally Invasive Stereotactical Radio-ablation of Adrenal Metastases as an Alternative to Surgery. Cancer Res Treat. 2016; 49(1):20-28. PMC: 5266381. DOI: 10.4143/crt.2016.057. View

12.

Palma D, Salama J, Lo S, Senan S, Treasure T, Govindan R . The oligometastatic state - separating truth from wishful thinking. Nat Rev Clin Oncol. 2014; 11(9):549-57. DOI: 10.1038/nrclinonc.2014.96. View

13.

Weickhardt A, Scheier B, Burke J, Gan G, Lu X, Bunn Jr P . Local ablative therapy of oligoprogressive disease prolongs disease control by tyrosine kinase inhibitors in oncogene-addicted non-small-cell lung cancer. J Thorac Oncol. 2012; 7(12):1807-1814. PMC: 3506112. DOI: 10.1097/JTO.0b013e3182745948. View

14.

Anselmo P, Casale M, Arcidiacono F, Trippa F, Rispoli R, Draghini L . Twelve-year results of LINAC-based radiosurgery for vestibular schwannomas. Strahlenther Onkol. 2019; 196(1):40-47. DOI: 10.1007/s00066-019-01498-7. View

15.

Chance W, Nguyen Q, Mehran R, Welsh J, Gomez D, Balter P . Stereotactic ablative radiotherapy for adrenal gland metastases: Factors influencing outcomes, patterns of failure, and dosimetric thresholds for toxicity. Pract Radiat Oncol. 2016; 7(3):e195-e203. DOI: 10.1016/j.prro.2016.09.005. View

16.

Brunner T, Nestle U, Adebahr S, Gkika E, Wiehle R, Baltas D . Simultaneous integrated protection : A new concept for high-precision radiation therapy. Strahlenther Onkol. 2016; 192(12):886-894. PMC: 5122615. DOI: 10.1007/s00066-016-1057-x. View

17.

Toesca D, Koong A, von Eyben R, Koong A, Chang D . Stereotactic body radiation therapy for adrenal gland metastases: Outcomes and toxicity. Adv Radiat Oncol. 2018; 3(4):621-629. PMC: 6200881. DOI: 10.1016/j.adro.2018.05.006. View

18.

Burjakow K, Fietkau R, Putz F, Achterberg N, Lettmaier S, Knippen S . Fractionated stereotactic radiation therapy for adrenal metastases: contributing to local tumor control with low toxicity. Strahlenther Onkol. 2018; 195(3):236-245. DOI: 10.1007/s00066-018-1390-3. View

19.

Zhang C, Leighl N, Wu Y, Zhong W . Emerging therapies for non-small cell lung cancer. J Hematol Oncol. 2019; 12(1):45. PMC: 6482588. DOI: 10.1186/s13045-019-0731-8. View

20.

Plichta K, Camden N, Furqan M, Hejleh T, Clamon G, Zhang J . SBRT to adrenal metastases provides high local control with minimal toxicity. Adv Radiat Oncol. 2017; 2(4):581-587. PMC: 5707423. DOI: 10.1016/j.adro.2017.07.011. View