Haidenberger Alfred, Heidorn Sarah-Charlotta, Kremer Nikolaus, Muacevic Alexander, Fürweger Christoph
Radiation Oncologist, European CyberKnife Center Munich.
Medical Physicist, European CyberKnife Center Munich.
Cureus. 2017 Mar 26;9(3):e1120. doi: 10.7759/cureus.1120.
The purpose of this study was to investigate the safety and efficacy of CyberKnife (CK) robotic radiosurgery for treatment of adrenal metastases.
We performed a retrospective analysis of 23 patients with adrenal metastases who had been treated with CK between October 2006 and December 2015. Fifteen patients received chemotherapy prior to radiosurgery, all patients underwent computer tomography (CT) fluoroscopically guided percutaneous placement of one to three gold fiducials into the adrenal gland. Nineteen patients were selected for single-fraction radiosurgery with a median dose of 22 Gy, four patients were treated in three fractions with a median dose of 13.5 Gy.
Median follow-up time was 23.6 months. Four patients (17%) experienced local relapse during the evaluation period with a mean time of 19 months to tumor progression. The actuarial local tumor control rate was 95% after one year and 81% after two years. Three of the four patients with local recurrence were retreated with CK radiosurgery. Dynamic tumor tracking enabled accurate treatment with correlation errors less than 2 mm, despite extensive respiration-induced target motion up to 22 mm. Apart from nausea directly after treatment in five patients, we observed no early or late treatment-related side effects.
Single fraction robotic radiosurgery for adrenal gland metastases is a safe and effective treatment option for patients who are not eligible for surgical resection.
本研究旨在探讨射波刀（CK）机器人放射外科治疗肾上腺转移瘤的安全性和有效性。
我们对2006年10月至2015年12月期间接受CK治疗的23例肾上腺转移瘤患者进行了回顾性分析。15例患者在放射外科治疗前接受了化疗，所有患者均在计算机断层扫描（CT）透视引导下经皮向肾上腺植入1至3个金标。19例患者接受单次分割放射外科治疗，中位剂量为22 Gy，4例患者分3次治疗，中位剂量为13.5 Gy。
中位随访时间为23.6个月。4例患者（17%）在评估期内出现局部复发，肿瘤进展的平均时间为19个月。1年时的精算局部肿瘤控制率为95%，2年时为81%。4例局部复发患者中的3例接受了CK放射外科再次治疗。尽管呼吸引起的靶区运动幅度高达22 mm，但动态肿瘤跟踪实现了误差小于2 mm的精确治疗。除5例患者在治疗后直接出现恶心外，我们未观察到早期或晚期与治疗相关的副作用。
对于不符合手术切除条件的患者，单次分割机器人放射外科治疗肾上腺转移瘤是一种安全有效的治疗选择。
