radiotherapy for symptomatic adrenal metastases
Edward M. Soffen, MD. University of
Pennsylvania Cancer 1990;65:1318
To evaluate the role of palliative
radiotherapy for adrenal metastases, a retrospective review was
performed on 16 patients treated between 1972 and 1988 for palliation
of symptomatic adrenal metastases. The median patient age was 56
years. In 15 cases lung cancer was the primary site (7
adenocarcinomas, 3 squamous cell carcinomas, 3 large cell carcinomas,
and 2 small cell carcinomas) and in 1 case there was an unknown
primary (squamous cell carcinoma). Ten of 16 patients were treated
with 3000 cGy to opposed anterior and posterior fields (300-cGy
fractions [four patients] and 250-cGy fractions [six patients]). The
remaining six patients were treated with a variety of techniques, with
total doses ranging from 2925 cGy to 4500 cGy. The patients were
analyzed for response at their first follow-up visit (2 to 4 weeks
after treatment). The overall
response rate was 75% (12 of 16 patients). Six patients (38%)
had complete pain relief without medication that lasted until death.
Two patients had marked pain relief, but still required analgesics.
Four patients had marked or moderate pain relief that did not continue
through follow-up. Four patients had minimal to no response. All
patients were observed until death, with a median survival time after
irradiation of 3 months (range, 0.5 to 11 months).
Although the prognosis for
patients with adrenal metastases is poor, radiotherapy to symptomatic
adrenal metastases can be administered with a high probability of
achieving effective palliation.
Radiation therapy for adrenal
Nippon Igaku Hoshasen Gakkai Zasshi.
PURPOSE: To evaluate the role of radiation
therapy for adrenal metastases. MATERIALS AND METHODS: Fourteen patients,
13 with primary lung carcinoma and one with primary unknown carcinoma,
received radiation therapy for adrenal metastases from 1984 to 1995 at the
Hyogo Medical Center for Adults. Total dose ranged from 16 Gy to 60 Gy,
and fractional dose from 1.6 Gy/ Fr to 3 Gy/Fr. RESULTS: Partial response
of the local tumor was recognized in 2 of 7 patients by CT imaging.
Pain relief was obtained in 7 of 8
patients. Median survival was 3 months, and 6-month survival was
28.6% in all patients. Among patients in the symptomatic group, who had
complaints of pain due to adrenal mass, survival was even worse (12.5% at
6 months). There were no severe complications, but 4 patients (29%) had
gastrointestinal symptoms. CONCLUSION:
Radiation therapy is useful for
the purpose of pain relief in adrenal metastases.
Radiation therapy for adrenal
gland metastases from hepatocellular carcinoma.
Jpn J Clin Oncol.
BACKGROUND: The adrenal gland is a common
site of extrahepatic metastases from hepatocellular carcinoma. However, it
has been the subject of few studies, and the optimal treatment remains
unclear. Methods previously tried for the management of adrenal gland
metastasis of hepatocellular carcinoma included surgical resection,
transarterial chemoembolization or percutaneous ethanol injection, on the
basis of case reports. External beam radiation therapy has seldom been
applied for patients with adrenal gland metastases. METHODS: We
retrospectively studied 22 patients with adrenal metastases from
hepatocellular carcinoma who were treated with limited-field external beam
radiation therapy. The radiation dose to the adrenal lesion ranged from 36
to 54 (median 50) Gy, while the intrahepatic lesions were treated with
either surgical resection or transarterial chemoembolization. RESULTS:
Among the 14 patients who had pain related to adrenal metastases, 11
(78.6%) had complete pain relief
without medication that lasted until death. Two (14.3%) patients had
marked pain relief, but still required analgesics. Partial responses were
observed in 73% of the patients. The median survival period for all
patients was 10 months. No patient died from complications related to
adrenal metastasis. Adverse effects were mild. CONCLUSION: Adrenal
metastases from hepatocellular carcinoma are sensitive to radiation
treatment. Radiation therapy with
50 Gy for adrenal gland metastases is a good palliative therapy with
Stereotactic Body Radiotherapy for Treatment of Adrenal Metastases.
Chawla S, .Int J Radiat Oncol Biol Phys. 2009 Feb 26.
Department of Radiation Oncology, University of Rochester Medical
Center, Rochester, NY.
PURPOSE: To investigate the dosimetry and outcomes of patients
undergoing stereotactic body radiotherapy (SBRT) for metastases to the
adrenal glands. METHODS AND MATERIALS: At the University of Rochester,
patients have been undergoing SBRT for limited metastases since 2001. We
retrospectively reviewed 30 patients who had undergone SBRT for adrenal
metastases from various primary sites, including lung (n = 20), liver (n
= 3), breast (n = 3), melanoma (n = 1), pancreas (n = 1), head and neck
(n = 1), and unknown primary (n = 1). RESULTS: Of the 30 patients, 14
with five or fewer metastatic lesions (including adrenal) underwent SBRT,
with the intent of controlling all known sites of metastatic disease,
and 16 underwent SBRT for palliation or prophylactic palliation of bulky
adrenal metastases. The prescribed dose
ranged from 16 Gy in 4 fractions to 50 Gy in 10 fractions. The median
dose was 40 Gy. Of the 30
patients, 24 had >3 months of follow-up with serial computed tomography.
Of these 24 patients, 1 achieved a complete response, 15 achieved a
partial response, 4 had stable disease, and 4 developed progressive
disease. No patient developed symptomatic progression of their adrenal
metastases. The 1-year
survival, local control, and distant control rate was 44%, 55%, and 13%,
respectively. No patient
developed Radiation Therapy Oncology Group Grade 2 or greater toxicity.
CONCLUSION: SBRT for adrenal metastases is well tolerated. Most patients
developed widespread metastases shortly after treatment. Local control
was poor, although this was a patient population selected for adverse
risk factors, such as bulky disease. Additional studies are needed to
determine the efficacy of SBRT for oligometastatic adrenal metastases,
given the propensity of these patients to develop further disease
Adrenalectomy for solitary
adrenal metastases from non-small cell lung cancer.
BACKGROUND: The treatment of patients with adrenal metastases
from lung cancer (non-small cell lung cancer, NSCLC) remains
controversial. Several studies of adrenalectomy in cases of isolated
adrenal metastases from NSCLC suggest that these patients could have
improved survival. Our aim is to define the history of patients after
resection of solitary metastases to the adrenal gland and to identify
characteristics of patients who achieved prolonged survival. METHODS:
Between January 1997 and July 2000, 11 patients underwent curative
resection for metastatic NSCLC of the adrenal gland in our institution.
In all patients who were accepted for curative adrenalectomy, the
primary NSCLC had been treated by complete resection. RESULTS: Eleven
patients (seven men and four women) with unilateral adrenal metastases
of NSCLC entered the study. Median age was 59 years (range 47-67 years).
There was no perioperative death. The overall median survival after
metastasectomy was 12.6 months (CI: 9.2-16.1 months). Patients with
curative resection and metachronous disease (n=6) had a median survival
of 30.9 months and tended to do better than patients with synchronous
adrenal metastases (n=5) (median survival: 10.3 months). CONCLUSIONS: We
conclude that adrenalectomy for clinically solitary, resectable
metastases can be performed safely. It appears reasonable that such
selected patients should be considered surgical candidates.