Evaluation of stereotactic body radiation therapy in the management of adrenal metastases from non-small cell lung cancer

Aims and Background: In this retrospective analysis, we evaluated the use of stereotactic body radiation therapy in the management of adrenal metastases from non-small cell lung cancer and report our single center experience. Methods and Study design: Fifteen non-small cell lung cancer patients (9 male, 6 female) with 17 adrenal metastases referred to Gulhane Military Medical Academy Radiation Oncology Department were treated using active breathing control-guided stereotactic body radiation therapy between December 2009 and October 2013. Dose per fraction was 10 Gy to deliver a total dose of 30 Gy over 3 consecutive days for all metastatic adrenal lesions. The mean gross tumor volume was 28.4 cc (range 6.6-101.5) and mean planning target volume was 57.4 cc (range 16.5-143.8). Results: At a median follow-up of 16 months, local control was 86.7% and overall survival was 33.3%. Median disease-free survival was 10 months. Treatment response according to RECIST was categorized as complete response in 3 patients (20%), partial response in 5 patients (33.3%), stable disease in 5 patients (33.3%), and progressive disease in 2 patients (13.3%). Most common acute toxicity was grade 1 nausea (n = 7) and grade 1 fatigue (n = 12). There was no case of grade >= 3 acute or late toxicity. Conclusions: Stereotactic body radiation therapy offers a safe and efficacious management strategy for adrenal metastases from non-small cell lung cancer by providing excellent local control with negligible treatment related toxicity.