Stereotactic body radiotherapy of adrenal metastases—A dose-finding study

Daniel Buergy, Florian Würschmidt, Eleni Gkika, Juliane Hörner-Rieber, Stefan Knippen, Sabine Gerum, Panagiotis Balermpas, Christoph Henkenberens, Theresa Voglhuber, Christine Kornhuber, Steffen Barczyk, Barbara Röper, Ali Rashid, Oliver Blanck, Andrea Wittig, Hans Ulrich Herold, Thomas Baptist Brunner, Reinhart A. Sweeney, Klaus Henning Kahl, Ilja Frank CiernikAnnette Ottinger, Victor Izaguirre, Florian Putz, Laila König, Michael Hoffmann, Stephanie Elisabeth Combs, Matthias Guckenberger, Judit Boda-Heggemann

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Optimal doses for the treatment of adrenal metastases with stereotactic radiotherapy (SBRT) are unknown. We aimed to identify dose-volume cut-points associated with decreased local recurrence rates (LRR). A multicenter database of patients with adrenal metastases of any histology treated with SBRT (biologically effective dose, BED10 ≥50 Gy, ≤12 fractions) was analyzed. Details on dose-volume parameters were required (planning target volume: PTV-D98%, PTV-D50%, PTV-D2%; gross tumor volume: GTV-D50%, GTV-mean). Cut-points for LRR were optimized using the R maxstat package. One hundred and ninety-six patients with 218 lesions were included, the largest histopathological subgroup was adenocarcinoma (n = 101). Cut-point optimization resulted in significant cut-points for PTV-D50% (BED10: 73.2 Gy; P =.003), GTV-D50% (BED10: 74.2 Gy; P =.006), GTV-mean (BED10: 73.0 Gy; P =.007), and PTV-D2% (BED10: 78.0 Gy; P =.02) but not for the PTV-D98% (P =.06). Differences in LRR were clinically relevant (LRR ≥ doubled for cut-points that were not achieved). Further dose-escalation was not associated with further improved LRR. PTV-D50%, GTV-D50%, and GTV-mean cut-points were also associated with significantly improved LRR in the adenocarcinoma subgroup. Separate dose optimizations indicated a lower cut-point for the PTV-D50% (BED10: 69.1 Gy) in adenocarcinoma lesions, other values were similar (<2% difference). Associations of cut-points with overall survival (OS) and progression-free survival were not significant but durable freedom from local recurrence was associated with OS in a landmark model (P <.001). To achieve a significant improvement of LRR for adrenal SBRT, a moderate escalation of PTV-D50% BED10 >73.2 Gy (adenocarcinoma: 69.1 Gy) should be considered.

Original languageEnglish
Pages (from-to)412-421
Number of pages10
JournalInternational Journal of Cancer
Issue number3
StatePublished - 1 Aug 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.


  • SBRT
  • adrenal
  • dose-finding
  • oligometastases


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