Mohnike K, Neumann K, Hass P, Seidensticker M, Seidensticker R, Pech M, Klose S, Streitparth T, Garlipp B, Benckert C, Wendler J J, Liehr U B, Schostak M, Göppner D, Gademann G, Ricke J
Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
DTZ am Frankfurter Tor, Kadiner Str.23, 10243, Berlin, Germany.
Strahlenther Onkol. 2017 Aug;193(8):612-619. doi: 10.1007/s00066-017-1120-2. Epub 2017 Mar 24.
To assess the efficacy, safety, and outcome of image-guided high-dose-rate (HDR) brachytherapy in patients with adrenal gland metastases (AGM).
From January 2007 to April 2014, 37 patients (7 female, 30 male; mean age 66.8 years, range 41.5-82.5 years) with AGM from different primary tumors were treated with CT-guided HDR interstitial brachytherapy (iBT). Primary endpoint was local tumor control (LTC). Secondary endpoints were time to untreatable progression (TTUP), time to progression (TTP), overall survival (OS), and safety. In a secondary analysis, risk factors with an influence on survival were identified.
The median biological equivalent dose (BED) was 37.4 Gy. Mean LTC after 12 months was 88%; after 24 months this was 74%. According to CTCAE criteria, one grade 3 adverse event occurred. Median OS after first diagnosis of AGM was 18.3 months. Median OS, TTUP, and TTP after iBT treatment were 11.4, 6.6, and 3.5 months, respectively. Uni- and multivariate Cox regression analyses revealed significant influences of synchronous disease, tumor diameter, and the total number of lesions on OS or TTUP or both.
Image-guided HDR-iBT is safe and effective. Treatment- and primary tumor-independent features influenced survival of patients with AGM after HDR-iBR treatment.
评估影像引导下高剂量率（HDR）近距离放射治疗肾上腺转移瘤（AGM）患者的疗效、安全性及预后。
2007年1月至2014年4月，37例（7例女性，30例男性；平均年龄66.8岁，范围41.5 - 82.5岁）来自不同原发肿瘤的AGM患者接受了CT引导下的HDR组织间近距离放射治疗（iBT）。主要终点为局部肿瘤控制（LTC）。次要终点为至不可治疗进展时间（TTUP）、至进展时间（TTP）、总生存期（OS）及安全性。在二次分析中，确定了影响生存的危险因素。
中位生物等效剂量（BED）为37.4 Gy。12个月时的平均LTC为88%；24个月时为74%。根据CTCAE标准，发生了1例3级不良事件。AGM首次诊断后的中位OS为18.3个月。iBT治疗后的中位OS、TTUP和TTP分别为11.4、6.6和3.5个月。单因素和多因素Cox回归分析显示，同步疾病、肿瘤直径和病变总数对OS或TTUP或两者均有显著影响。
影像引导下的HDR - iBT安全有效。治疗及原发肿瘤无关的特征影响了HDR - iBR治疗后AGM患者的生存。
