Hamidi Oksana, Miljanic Mihailo, Tumyan Gayane, Christie Alana, Mirfakhraee Sasan, Ali Sadia, Dohopolski Michael, Gottumukkala Sujana, Brugarolas James, Timmerman Robert, Hannan Raquibul
Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Cancers (Basel). 2024 Sep 12;16(18):3140. doi: 10.3390/cancers16183140.
Adrenal metastases are often treated with stereotactic ablative radiation (SAbR). We aimed to assess the incidence, timing, and factors associated with the development of primary adrenal insufficiency (PAI) following SAbR.
A retrospective cohort study comprised 66 consecutive patients (73% men, median age 61 years) who underwent SAbR for adrenal metastasis.
The series encompassed metastases from renal cell carcinoma (41%), lung tumors (38%), colorectal adenocarcinoma (9%), melanoma (5%), and others (7%). Median follow-up was 17 months from SAbR. Nine (14%) patients developed PAI at a median of 4.3 months (range, 0.7-20.2). The incidence of PAI was 44% in patients with prior adrenalectomy receiving unilateral SAbR, 44% with bilateral SAbR, 2% with unaffected contralateral gland, and 0% with bilateral metastases treated with unilateral SAbR. PAI was associated with prior adrenalectomy (odds ratio [OR] 32) and bilateral SAbR (OR 8.2), but not age, sex, metastasis size, or biological effective dose. Post-SAbR 6-month and 1-year local control rates were 82% and 75%, respectively.
Patients undergoing SAbR for adrenal metastasis are at high risk of developing PAI. PAI is associated with bilateral SAbR and contralateral adrenalectomy. PAI is unlikely with a remaining unaffected adrenal gland or in the setting of bilateral adrenal metastases with unilateral SAbR.
肾上腺转移瘤常采用立体定向消融放疗（SAbR）治疗。我们旨在评估SAbR后原发性肾上腺功能不全（PAI）的发生率、发生时间及相关因素。
一项回顾性队列研究纳入了66例连续接受SAbR治疗肾上腺转移瘤的患者（73%为男性，中位年龄61岁）。
该系列包括肾细胞癌转移瘤（41%）、肺肿瘤转移瘤（38%）、结直肠癌转移瘤（9%）、黑色素瘤转移瘤（5%）和其他转移瘤（7%）。自SAbR起的中位随访时间为17个月。9例（14%）患者发生PAI，中位时间为4.3个月（范围0.7 - 20.2个月）。既往接受过肾上腺切除术且接受单侧SAbR治疗的患者中PAI发生率为44%，接受双侧SAbR治疗的患者中为44%，对侧肾上腺未受影响的患者中为2%，单侧SAbR治疗双侧转移瘤的患者中为0%。PAI与既往肾上腺切除术（比值比[OR] 32）和双侧SAbR（OR 8.2）相关，但与年龄、性别、转移瘤大小或生物等效剂量无关。SAbR后6个月和1年的局部控制率分别为82%和75%。
接受SAbR治疗肾上腺转移瘤的患者发生PAI的风险较高。PAI与双侧SAbR和对侧肾上腺切除术相关。保留未受影响的肾上腺或单侧SAbR治疗双侧肾上腺转移瘤时发生PAI的可能性较小。
