Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer-Victoria, Radiation Oncology, Victoria, British Columbia, Canada.
Int J Radiat Oncol Biol Phys. 2021 Jun 1;110(2):438-443. doi: 10.1016/j.ijrobp.2020.12.038. Epub 2020 Dec 30.
The adrenal gland is a common site of metastasis in patients with advanced cancer, but it is rarely symptomatic. A subset of patients develop a complex pain syndrome with anorexia, nausea, and poorly localized visceral pain in the back, flank, or epigastric region. These symptoms can affect quality of life and are occasionally challenging to palliate. The role of palliative radiation therapy (PRT) in these patients is unclear. This population-based retrospective study evaluates PRT practices for patients with adrenal metastases and aims to describe treatment response and acute toxicity.
Patients who received PRT to an adrenal metastasis between the years of 1985 and 2015 were identified in a provincial database. Patient demographics, tumor factors, symptom burden, radiation therapy prescriptions, and response to treatment were collected. Variables were summarized using descriptive statistics. The Kaplan-Meier test was used to assess survival. Factors associated with clinical response were evaluated using univariate and logistic regression analysis. Factors associated with survival were evaluated using univariate and Cox proportional hazards model.
One hundred patients who received 103 separate courses of PRT were identified. The majority had a lung primary (82%). The most common baseline symptoms were pain (90%) and gastrointestinal upset (13%). Prescriptions ranged from 600 cGy in a single fraction to 4500 cGy in 25 fractions. Seventy percent of patients experienced an improvement in pain (either a complete or partial response). Forty-three percent of patients developed acute toxicity from treatment. Median survival was 3 months.
Compared with other anatomic sites, conventional PRT is uncommonly delivered to adrenal metastases. Despite heterogeneity in tumor histology and radiation therapy prescriptions, treatment was associated with an overall pain response of 70%. Prophylactic antiemetics to decrease radiation-induced nausea are required before treatment. Given the poor prognosis of this population, short fractionations are indicated.
肾上腺是晚期癌症患者转移的常见部位，但通常无症状。一部分患者出现复杂的疼痛综合征，伴有厌食、恶心和背部、肋部或上腹部位置不明确的内脏疼痛。这些症状会影响生活质量，且偶尔难以缓解。对于这些患者，姑息性放射治疗（PRT）的作用尚不清楚。本基于人群的回顾性研究评估了接受肾上腺转移 PRT 的患者的治疗情况，旨在描述治疗反应和急性毒性。
在省级数据库中确定了 1985 年至 2015 年期间接受 PRT 治疗的肾上腺转移患者。收集了患者的人口统计学、肿瘤因素、症状负担、放射治疗处方以及治疗反应等信息。使用描述性统计方法总结变量。采用 Kaplan-Meier 检验评估生存情况。采用单变量和逻辑回归分析评估与临床反应相关的因素。采用单变量和 Cox 比例风险模型评估与生存相关的因素。
共确定了 100 名患者接受了 103 次单独的 PRT 治疗。大多数患者的原发灶为肺部（82%）。最常见的基线症状是疼痛（90%）和胃肠道不适（13%）。处方剂量范围从单次 600 cGy 到 25 次 4500 cGy。70%的患者疼痛得到改善（完全或部分缓解）。43%的患者在治疗后出现急性毒性。中位生存时间为 3 个月。
与其他解剖部位相比，常规 PRT 很少用于肾上腺转移。尽管肿瘤组织学和放射治疗处方存在异质性，但治疗后总体疼痛反应率为 70%。治疗前需要预防性使用止吐药以减少放射性恶心。鉴于该人群的预后较差，建议采用短疗程放射治疗。
