Stereotactic ablative radiotherapy for adrenal gland metastases: Factors influencing outcomes, patterns of failure, and dosimetric thresholds for toxicity

被引:46
作者
Chance, William W. [1 ]
Quynh-Nhu Nguyen [1 ]
Mehran, Reza [2 ]
Welsh, James W. [1 ]
Gomez, Daniel R. [1 ]
Balter, Peter [3 ]
Komaki, Ritsuko [1 ]
Liao, Zhongxing [1 ]
Chang, Joe Y. [1 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA
[2] Univ Texas MD Anderson Canc Ctr, Dept Thorac & Cardiovasc Surg, Houston, TX 77030 USA
[3] Univ Texas MD Anderson Canc Ctr, Dept Radiat Phys, Houston, TX 77030 USA
关键词
BODY RADIATION-THERAPY; CELL LUNG-CANCER; STAGE-I; SBRT;
D O I
10.1016/j.prro.2016.09.005
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: We report our single-institution experience with stereotactic ablative radiotherapy (SABR) for adrenal metastasis and identify factors influencing outcomes, patterns of failure, and dosimetric thresholds for toxicity. Methods and materials: We identified patients with adrenal metastases treated with SABR from 2009 to 2015. Toxicity was evaluated with Common Terminology Criteria for Adverse Events v4.0. Local failures were categorized as in-field, marginal, or out-of-field. New or progressive disease outside the treated adrenal gland was considered distant failure. Survival and time to local and distant failure were estimated by the Kaplan-Meier method. Prognostic factors were evaluated with a Cox proportional hazards model. Fisher's exact tests were used to compare toxicity between dosimetric thresholds. Results: Forty-three patients with 49 adrenal metastases (84% from lung) were treated with SABR to a median prescribed dose of 60 Gy in 10 fractions. Median overall survival time was 19 months, and 1- and 2-year rates were 65% and 42%, respectively. Bilateral adrenal metastases were associated with worse overall survival (P = .01). Median progression-free survival (PFS) time was 6 months, with most progressions being distant failure (most often to brain or bone). PFS was better in patients with a solitary adrenal metastasis (P = .03). Median time to local failure was not reached; the 1-year freedom from local failure rate was 74%. Nine failures were in field and 1 was marginal; no local failures occurred in lesions treated with biologically equivalent doses of >100 Gy. No patient experienced grade 3-5 toxicity. Low-grade gastrointestinal toxicity was common, but grade 2 toxicity was avoided in patients with a maximum stomach-bowel point dose of <= 50 Gy (P = .03). Low-grade adrenal insufficiency was common with bilateral treatment. Conclusion: SABR was well tolerated and resulted in good 1-year local control; PFS was promising for patients with solitary metastases. Low-grade toxicity was common, but can be minimized with strict dosimetric constraints. (C) 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:E195 / E203
页数:9
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