Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Am J Clin Oncol. 2020 Feb;43(2):107-114. doi: 10.1097/COC.0000000000000634.
The role of local disease control in the oligometastatic setting is evolving. Stereotactic body radiation therapy (SBRT) is a noninvasive treatment option for oligometastases; however, using ablative radiation doses for adrenal metastases raises concern given the proximity to radiosensitive organs. Novel treatment techniques may allow for selective dose escalation to improve local control (LC) while minimizing dose to nearby critical structures.
We retrospectively reviewed patients with adrenal oligometastases treated with SBRT from 2013 to 2018. LC, disease-free survival, and overall survival were estimated using Kaplan-Meier methods. Predictors of outcomes were evaluated by log-rank and Cox proportional hazard analyses.
We identified 45 adrenal oligometastases in 41 patients treated with SBRT. The median age at treatment was 67 years (range, 40 to 80). The most common primary histologies were non-small cell lung cancer (51%), renal cell carcinoma (24%), and small cell lung cancer (10%). The median prescription dose was 50 Gy (range, 25 to 60 Gy), with 30 (67%) lesions receiving ≥50 Gy and 14 (31%) receiving 60 Gy. In total, 26 (58%) lesions received a simultaneous-integrated boost. Of the 42 treatment simulations, 26 (62%) were supine, 5 (12%) prone, and 11 (26%) in the left lateral decubitus position. At a median follow-up of 10.5 months, there were 3 local failures with a 12-month LC rate of 96%.
Adrenal SBRT for oligometastatic disease is a feasible, noninvasive option with excellent LC and minimal toxicity. Lesions in close proximity to radiosensitive organs may benefit from dynamic patient positioning and selective simultaneous-integrated boost techniques to allow for dose escalation, while also limiting toxicity risks.
局部疾病控制在寡转移情况下的作用正在发生变化。立体定向体部放射治疗（SBRT）是寡转移的一种非侵入性治疗选择；然而，对于靠近放射敏感器官的肾上腺转移灶，使用消融性辐射剂量会引起关注。新的治疗技术可能允许选择性地提高剂量以提高局部控制率（LC），同时最大限度地减少对附近关键结构的剂量。
我们回顾性地分析了 2013 年至 2018 年间接受 SBRT 治疗的肾上腺寡转移患者。使用 Kaplan-Meier 方法估计 LC、无疾病生存率和总生存率。通过对数秩和 Cox 比例风险分析评估预后的预测因素。
我们共确定了 41 例患者的 45 个肾上腺寡转移灶，接受 SBRT 治疗。治疗时的中位年龄为 67 岁（范围，40 至 80 岁）。最常见的原发组织学类型是非小细胞肺癌（51%）、肾细胞癌（24%）和小细胞肺癌（10%）。中位处方剂量为 50Gy（范围，25 至 60Gy），30 个（67%）病灶接受≥50Gy，14 个（31%）病灶接受 60Gy。总共 26 个（58%）病灶接受了同步整合增敏。在 42 次治疗模拟中，26 次（62%）为仰卧位，5 次（12%）为俯卧位，11 次（26%）为左侧卧位。中位随访 10.5 个月，有 3 例局部失败，12 个月 LC 率为 96%。
肾上腺 SBRT 治疗寡转移疾病是一种可行的、非侵入性的选择，具有良好的 LC 和最小的毒性。靠近放射敏感器官的病灶可能受益于动态患者定位和选择性的同步整合增敏技术，以允许提高剂量，同时也降低毒性风险。
