Haisraely Ory, Weiss Ilana, Jaffe Marcia, Appel Sarit, Person-Kaidar Orit, Symon Zvi, Ben-Ayun Maoz, Dubinski Sergi, Lawrence Yaacov
Sheba Medical Center, Radiation Oncology Unit, Israel.
University of Nicosia (UNIC) Medical School, Cyprus.
Clin Transl Radiat Oncol. 2024 May 4;47:100788. doi: 10.1016/j.ctro.2024.100788. eCollection 2024 Jul.
PURPOSE/OBJECTIVES: Stereotactic body radiotherapy (SBRT) is an effective treatment for oligometastatic disease in multiple sites. However, the optimal radiation dose for long-term local control of adrenal metastases has yet to be determined. The aim of this study is to evaluate outcomes of adrenal SBRT and to evaluate factors that correlate with local control.
MATERIALS/METHODS: After IRB approval, a retrospective data review of patients treated with SBRT for adrenal metastases at a medical center in Israel between 2015 and 2021 was conducted. A biological effective dose was calculated using an alpha beta ratio of 10. Kaplan Meier and Cox regression were calculated using SPSS software to describe the hazard ratio for local control and survival.
83 cases of adrenal SBRT were identified. The average age was 67 (range 42-92 years old). Non-small cell lung cancer was the primary site in 44 % of patients. A total of 70 % of the patients had oligometastatic disease (less than five lesions), and the rest were polymetastatic, responding to systemic therapy with oligo progression in the adrenal. The average gross tumor volume (GTV) was 42 ml. Respiratory control was applied in 88 % of cases; 49.3 % used 4-D/ITV, and 38.5 % used breath-hold or continuous positive airway pressure (CPAP) with free breathing. On multivariable analysis, Dose above 75 Gy (biological effective Dose) (HR = 0.41, p = 0.031), Dose above 8 Gy per fraction (HR = 0.53p = 0.038), and breath-holds or CPAP (HR = 0.65, p = 0.047) were significant for local control. From multivariable analysis, we computed a predicted nomogram curve using seven clinical parameters to evaluate local control odds.
In this single institution series reported to date, we found unilateral adrenal SBRT safe, yet bilateral treatment harbors a risk of adrenal insufficiency. Biological effective Dose > 75 Gy (BED), motion management with breath-hold or CPAP, and Dose per fraction > 8 Gy were the enhanced local controls. We propose a nomogram to help in decision-making regarding total Dose and Dose per fraction when treating adrenal SBRT.
目的/目标：立体定向体部放疗（SBRT）是治疗多部位寡转移疾病的有效方法。然而，肾上腺转移瘤长期局部控制的最佳放疗剂量尚未确定。本研究的目的是评估肾上腺SBRT的治疗效果，并评估与局部控制相关的因素。
材料/方法：经机构审查委员会（IRB）批准，对2015年至2021年期间在以色列一家医疗中心接受SBRT治疗肾上腺转移瘤的患者进行回顾性数据审查。使用α/β比值为10计算生物等效剂量。使用SPSS软件计算Kaplan Meier和Cox回归，以描述局部控制和生存的风险比。
共确定83例肾上腺SBRT病例。平均年龄为67岁（范围42 - 92岁）。44%的患者原发部位为非小细胞肺癌。70%的患者患有寡转移疾病（少于5个病灶），其余为多转移，对全身治疗有反应，肾上腺出现寡进展。平均肿瘤总体积（GTV）为42毫升。88%的病例采用了呼吸控制；49.3%使用4D/ITV，38.5%在自由呼吸时使用屏气或持续气道正压通气（CPAP）。多变量分析显示，生物等效剂量高于75 Gy（HR = 0.41，p = 0.031）、每次分割剂量高于8 Gy（HR = 0.53，p = 0.038）以及屏气或CPAP（HR = 0.65，p = 0.047）对局部控制具有显著意义。通过多变量分析，我们使用七个临床参数计算了预测列线图曲线，以评估局部控制概率。
在迄今为止报道的这个单机构系列研究中，我们发现单侧肾上腺SBRT是安全的，但双侧治疗存在肾上腺功能不全的风险。生物等效剂量>75 Gy（BED）、采用屏气或CPAP进行运动管理以及每次分割剂量>8 Gy可增强局部控制。我们提出一个列线图，以帮助在治疗肾上腺SBRT时做出关于总剂量和每次分割剂量的决策。
