Abstract
Although the adrenal glands are not common sites of metastasis from hepatocellular carcinoma (HCC), this metastasis can be met in patients with advanced HCC in some clinical settings. However, the effectiveness of radiotherapy against such metastases is unclear. Therefore, we performed the present multi-institutional study to investigate tumor response, overall survival (OS), treatment-related toxicity, and prognostic factors after radiotherapy. We retrospectively reviewed 134 patients who completed a planned radiotherapy for their adrenal metastases. Complete response was noted in 6 (4.3%), partial response in 48 (34.0%), and stable disease in 78 patients (55.3%). The median OS was 12.8 months, and the 1-, 2-, and 5-year OS rates were 53.1%, 23.9%, and 9.3%, respectively. Grade 3 anorexia occurred in 2 patients, grade 3 diarrhea in 1, and grade 3 fatigue in 1. Multivariate analyses revealed that the following factors had significant effects on OS: controlled intrahepatic tumor; controlled extrahepatic metastasis; and Child-Pugh class A. Although patients with adrenal metastasis from HCC had poor OS, radiotherapy provided an objective response rate of 38.3% and disease stability of 93.6%, with minimal adverse events. Therefore, radiotherapy for these patients could represent a good treatment modality, especially for patients with controlled intrahepatic tumors, controlled extrahepatic metastasis, and good hepatic function.
Highlights
With advances in diagnosis and treatment of hepatocellular carcinoma (HCC), survival outcomes have increased considerably over time
The inclusion criteria for this study were as follows: (1) HCC was diagnosed based on the guidelines of the American Association for the Study of Liver Diseases; (2) adrenal metastasis was diagnosed clinically by computed tomography (CT), and/or magnetic resonance imaging (MRI), and/or angiograph; (3) age 20 years; (4) completion of planned radiotherapy; (5) treatment with modern radiotherapy techniques, including three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy or stereotactic body radiotherapy (SBRT); (6) no prior history of treatment for adrenal metastasis
A total of 134 patients with adrenal metastases from HCC were included in the present study (Table 1)
Summary
With advances in diagnosis and treatment of hepatocellular carcinoma (HCC), survival outcomes have increased considerably over time. It has generally been thought that extrahepatic metastasis is not uncommon and is observed more frequently due to improved diagnostic methods and prolonged patient survival [2]. The most frequent metastatic site is the lung, while other common metastatic sites include lymph nodes, bone, and adrenal glands [2,3,4]. The adrenal glands are not common metastatic sites of HCC, with an incidence of 8% in autopsies and 8.8–16.9% in HCC patients with extrahepatic metastasis, this metastasis can be met in patients with advanced HCC in some clinical settings [2,4,5,6,7,8,9]. An optimal treatment strategy has yet to be established
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