Stereotactic or conformal radiotherapy for adrenal metastases: Patient characteristics and outcomes in a multicenter analysis

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 B. Brunner, Rainer J. Klement, Klaus Henning Kahl, Ilja F. CiernikAnnette Ottinger, Victor Izaguirre, Florian Putz, Laila König, Michael Hoffmann, Stephanie E. Combs, Matthias Guckenberger, Judit Boda-Heggemann

Research output: Contribution to journalArticlepeer-review

Abstract

To report outcome (freedom from local progression [FFLP], overall survival [OS] and toxicity) after stereotactic, palliative or highly conformal fractionated (>12) radiotherapy (SBRT, Pall-RT, 3DCRT/IMRT) for adrenal metastases in a retrospective multicenter cohort within the framework of the German Society for Radiation Oncology (DEGRO). Adrenal metastases treated with SBRT (≤12 fractions, biologically effective dose [BED10] ≥ 50 Gy), 3DCRT/IMRT (>12 fractions, BED10 ≥ 50 Gy) or Pall-RT (BED10 < 50 Gy) were eligible for this analysis. In addition to unadjusted FFLP (Kaplan-Meier/log-rank), we calculated the competing-risk-adjusted local recurrence rate (CRA-LRR). Three hundred twenty-six patients with 366 metastases were included by 21 centers (median follow-up: 11.7 months). Treatment was SBRT, 3DCRT/IMRT and Pall-RT in 260, 27 and 79 cases, respectively. Most frequent primary tumors were non-small-cell lung cancer (NSCLC; 52.5%), SCLC (16.3%) and melanoma (6.7%). Unadjusted FFLP was higher after SBRT vs Pall-RT (P =.026) while numerical differences in CRA-LRR between groups did not reach statistical significance (1-year CRA-LRR: 13.8%, 17.4% and 27.7%). OS was longer after SBRT vs other groups (P <.05) and increased in patients with locally controlled metastases in a landmark analysis (P <.0001). Toxicity was mostly mild; notably, four cases of adrenal insufficiency occurred, two of which were likely caused by immunotherapy or tumor progression. Radiotherapy for adrenal metastases was associated with a mild toxicity profile in all groups and a favorable 1-year CRA-LRR after SBRT or 3DCRT/IMRT. One-year FFLP was associated with longer OS. Dose-response analyses for the dataset are underway.

Original languageEnglish
Pages (from-to)358-370
Number of pages13
JournalInternational Journal of Cancer
Volume149
Issue number2
DOIs
StatePublished - 15 Jul 2021

Bibliographical note

Funding Information:
None of the authors had direct conflicts of interest. Daniel Buergy reports personal fees from NB Capital ApS, personal fees from Nordic Biotech, personal fees from Siemens AG, personal fees from b.e. Imaging GmbH, outside the submitted work; Juliane Hörner‐Rieber received speaker fees and travel reimbursement from ViewRay Inc, as well as travel reimbursement form IntraOP Medical and Elekta Instrument AB outside the submitted work; Florian Putz received research grants and speaker fees from Siemens Healthcare AG outside the submitted work; Matthias Guckenberger received grants from Viewray, Varian and AstraZeneca outside the submitted work; Klaus Henning Kahl received travel and speakers fees from Varian, Elekta, Zeiss Meditec MDS, Bristol Myers Squibb, Astra Zeneca and Medical Intelligence outside the submitted work. All the other authors reported no potential conflicts of interest.

Publisher Copyright:
© 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of Union for International Cancer Control.

Keywords

  • SBRT
  • adrenal
  • oligometastases
  • outcome
  • patterns of care

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