Short-term outcomes and clinical efficacy of stereotactic body radiation therapy (SBRT) in treatment of adrenal gland metastases from lung cancer

Xianzhi Zhao,Haipeng Ren,Jianfeng Fei,Zhiyong Yuan,Xiaofei Zhu,Xiaoping Ju,Yangsen Cao,Huojun Zhang

doi:10.1186/s13014-018-1152-5

Abstract

BackgroundTo assess the efficacy and safety of stereotactic body radiation therapy (SBRT) in the management of adrenal gland metastases (AGMs) from lung cancer. Moreover, it is the first two-institutional experience and the largest-to-date study to report the safety and efficacy of SBRT for inoperable AGM from lung cancer.MethodsIn this retrospective study, 30 patients (27 males, 3 females) with 32 AGMs were treated by SBRT from October 2006 to June 2016. Of these, 11 patients were treated with the intent of controlling all known metastatic sites and 19 for palliation of bulky AGMs. Follow-up was performed every 3 months for evaluations of efficacy and safety. Factors predictive of overall survival (OS) and local control (LC) were identified with univariate and then multivariate analysis.ResultsMedian follow-up time was 10.7 months (2.9–96.4 months). The complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) rates were 23.3%, 33.3%, 33.3% and 16.7% respectively. The 6-month, 1, and 2-year LC rates were 96.9%, 96.9%, and 72.7% respectively. Additionally, the 6-month, 1, and 2-year OS rates were 85.6%, 58.1%, and 54.0% respectively while 6-month, 1, and 2-year progression free survival (PFS) rates were 39.5%, 24.6%, and 8.2%, respectively. All the patients with cancer-induced pain (8 with abdominal pain and 6 with lumbar back pain) had significant alleviations after SBRT. The treatment was well tolerated with only 1 patient reporting grade-3 diarrhoea. No predictors of OS and LC were found after multivariate analysis, while it was demonstrated that biologic equivalent dose (BED10, α/β = 10) ≥85.5Gy (P = 0.007) and gross tumor volume < 30 ml (P = 0.003) correlated with LC only after univariate analysis.ConclusionSBRT is a safe and effective treatment modality in the management of AGMs from lung cancer with high LC rates and acceptable toxicity.

Highlights

To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) in the management of adrenal gland metastases (AGMs) from lung cancer
Surgery is considered as a curative option for some isolated metastases, but the adrenalectomy sometimes may result in adrenal insufficiency and perioperative complications [3]
It may be implied that SBRT was a promising modality in the management of AGMs from lung cancer, especially for a palliative purpose to relieve various symptoms caused by the metastases

Summary

Introduction

To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) in the management of adrenal gland metastases (AGMs) from lung cancer. Adrenal gland metastases (AGMs) from lung cancer are usually characterized by insidious onset and patients only occasionally have back or abdominal pain due to a large or rapidly growing tumor. An obvious increase in tumor burden may prompt systemic aggressive treatment. For those with AGMs who may have already received first-line chemotherapy and have disease progressions thereafter, alternative regimens might not provide survival benefits, as well as probably contribute to high incidences of toxicity. A non-invasive, safe and effective alternative is required

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Results

Discussion

Conclusion