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. Ciernik; Annette Ottinger; Victor Izaguirre; Florian Putz; Laila König; Michael Hoffmann; Stephanie E. Combs; Matthias Guckenberger; Judit Boda-Heggemann

doi:10.1002/ijc.33546

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 journal › Article › peer-review

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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 language	English
Pages (from-to)	358-370
Number of pages	13
Journal	International Journal of Cancer
Volume	149
Issue number	2
DOIs	https://doi.org/10.1002/ijc.33546
State	Published - 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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10.1002/ijc.33546

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Buergy, D., Würschmidt, F., Gkika, E., Hörner-Rieber, J., Knippen, S., Gerum, S., Balermpas, P., Henkenberens, C., Voglhuber, T., Kornhuber, C., Barczyk, S., Röper, B., Rashid, A., Blanck, O., Wittig, A., Herold, H. U., Brunner, T. B., Klement, R. J., Kahl, K. H., ... Boda-Heggemann, J. (2021). Stereotactic or conformal radiotherapy for adrenal metastases: Patient characteristics and outcomes in a multicenter analysis. International Journal of Cancer, 149(2), 358-370. https://doi.org/10.1002/ijc.33546

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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.",

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author = "Daniel Buergy and Florian W{\"u}rschmidt and Eleni Gkika and Juliane H{\"o}rner-Rieber and Stefan Knippen and Sabine Gerum and Panagiotis Balermpas and Christoph Henkenberens and Theresa Voglhuber and Christine Kornhuber and Steffen Barczyk and Barbara R{\"o}per and Ali Rashid and Oliver Blanck and Andrea Wittig and Herold, {Hans Ulrich} and Brunner, {Thomas B.} and Klement, {Rainer J.} and Kahl, {Klaus Henning} and Ciernik, {Ilja F.} and Annette Ottinger and Victor Izaguirre and Florian Putz and Laila K{\"o}nig and Michael Hoffmann and Combs, {Stephanie E.} and Matthias Guckenberger and Judit Boda-Heggemann",

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Buergy, D, Würschmidt, F, Gkika, E, Hörner-Rieber, J, Knippen, S, Gerum, S, Balermpas, P, Henkenberens, C, Voglhuber, T, Kornhuber, C, Barczyk, S, Röper, B, Rashid, A, Blanck, O, Wittig, A, Herold, HU, Brunner, TB, Klement, RJ, Kahl, KH, Ciernik, IF, Ottinger, A, Izaguirre, V, Putz, F, König, L, Hoffmann, M, Combs, SE, Guckenberger, M & Boda-Heggemann, J 2021, 'Stereotactic or conformal radiotherapy for adrenal metastases: Patient characteristics and outcomes in a multicenter analysis', International Journal of Cancer, vol. 149, no. 2, pp. 358-370. https://doi.org/10.1002/ijc.33546

TY - JOUR

T1 - Stereotactic or conformal radiotherapy for adrenal metastases

T2 - Patient characteristics and outcomes in a multicenter analysis

AU - Buergy, Daniel

AU - Würschmidt, Florian

AU - Gkika, Eleni

AU - Hörner-Rieber, Juliane

AU - Knippen, Stefan

AU - Gerum, Sabine

AU - Balermpas, Panagiotis

AU - Henkenberens, Christoph

AU - Voglhuber, Theresa

AU - Kornhuber, Christine

AU - Barczyk, Steffen

AU - Röper, Barbara

AU - Rashid, Ali

AU - Blanck, Oliver

AU - Wittig, Andrea

AU - Herold, Hans Ulrich

AU - Brunner, Thomas B.

AU - Klement, Rainer J.

AU - Kahl, Klaus Henning

AU - Ciernik, Ilja F.

AU - Ottinger, Annette

AU - Izaguirre, Victor

AU - Putz, Florian

AU - König, Laila

AU - Hoffmann, Michael

AU - Combs, Stephanie E.

AU - Guckenberger, Matthias

AU - Boda-Heggemann, Judit

PY - 2021/7/15

Y1 - 2021/7/15

N2 - 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.

AB - 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.

KW - SBRT

KW - adrenal

KW - oligometastases

KW - outcome

KW - patterns of care

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U2 - 10.1002/ijc.33546

DO - 10.1002/ijc.33546

M3 - Artículo

C2 - 33682927

AN - SCOPUS:85103287163

SN - 0020-7136

VL - 149

SP - 358

EP - 370

JO - International Journal of Cancer

JF - International Journal of Cancer

IS - 2

ER -

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

Abstract

Bibliographical note

Keywords

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