Giraud Nicolas, Palacios Miguel A, van Sornsen de Koste John R, Marzo Antonio M, van Rossum Peter S N, Schneiders Famke L, Senan Suresh
Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, De Boelelaan 1117, Amsterdam, the Netherlands.
Cancer Center Amsterdam, Amsterdam, the Netherlands.
Clin Transl Radiat Oncol. 2025 Jul 7;54:101011. doi: 10.1016/j.ctro.2025.101011. eCollection 2025 Sep.
Splenic irradiation can result in life-threatening infections. Updated dose constraints have been recommended for patients undergoing chemoradiotherapy and conventional radiotherapy but splenic constraints were not specified in trials of stereotactic ablative radiotherapy (SABR). We studied splenic doses in patients undergoing SABR for adrenal metastases and late changes in splenic volume (SV).
Patients treated with breath-hold MR-guided SABR for adrenal metastases were identified from an Ethics-approved database. Splenic dose constraints were not routinely used. The spleen was delineated retrospectively on both breath-hold CT and MR-scans. Mean spleen dose (MSD) and relative V values were derived from the baseline plan. SV was measured on available follow-up CT scans at 6-12-24 months. Regression analyses were performed to assess SV changes in relation to splenic dose and other parameters.
SABR was delivered to 113 adrenal tumors mostly using 5 fractions (64 % of tumors), 3 fractions (19 %) or a single fraction (14 %). Systemic therapy was administered during or within 3 months preceding/after SABR in 51 % of patients. Left-sided tumors comprised 56 % of total, and baseline median MSD and V were 9.7 Gy (range 1.5-28.4 Gy) and 46.3 % (range 0-100 %), respectively. Corresponding values for right-sided adrenal plans were 1.5 Gy (0.2-5.9 Gy) and 0 % (0-6.2 %), respectively. In multivariable analysis, a higher MSD was significantly associated with left laterality (p < 0.001), higher prescription dose (p = 0.02), and larger GTV (p < 0.001). An MSD of > 10 Gy was observed in 28 patients (25 %). Among these, a greater than 20 % decrease in SV was found in 46 % of patients with available follow-up at 6 months (n = 59), 40 % at 12 months (n = 47) and 50 % at 24 months (n = 31).
Substantial reductions in spleen volume occur in 40-50 % of patients treated with adrenal SABR with an MSD of >10 Gy. The clinical relevance of splenic atrophy merits further study.
脾脏照射可导致危及生命的感染。对于接受放化疗和传统放疗的患者，已推荐了更新后的剂量限制，但在立体定向消融放疗（SABR）试验中未明确脾脏的剂量限制。我们研究了接受SABR治疗肾上腺转移瘤患者的脾脏剂量以及脾脏体积（SV）的后期变化。
从一个经伦理批准的数据库中识别出接受屏气磁共振引导下SABR治疗肾上腺转移瘤的患者。未常规使用脾脏剂量限制。在屏气CT和磁共振扫描上对脾脏进行回顾性勾画。平均脾脏剂量（MSD）和相对V值来自基线计划。在6个月、12个月和24个月的可用随访CT扫描上测量SV。进行回归分析以评估SV变化与脾脏剂量及其他参数的关系。
113例肾上腺肿瘤接受了SABR治疗，大多采用5次分割（64%的肿瘤）、3次分割（19%）或单次分割（14%）。51%的患者在SABR期间或之前/之后3个月内接受了全身治疗。左侧肿瘤占总数的56%，基线时MSD中位数和V分别为9.7 Gy（范围1.5 - 28.4 Gy）和46.3%（范围0 - 100%）。右侧肾上腺计划的相应值分别为1.5 Gy（0.2 - 5.9 Gy）和0%（0 - 6.2%）。在多变量分析中，较高的MSD与左侧（p < 0.001）、较高的处方剂量（p = 0.02）和较大的GTV（p < 0.001）显著相关。28例患者（25%）的MSD > 10 Gy。其中，在6个月（n = 59）有可用随访的患者中，46%的患者SV下降超过20%；12个月（n = 47）时为40%；24个月（n = 31）时为�0%。
在接受肾上腺SABR且MSD > 10 Gy的患者中，40% - 50%出现脾脏体积大幅减小。脾脏萎缩的临床相关性值得进一步研究。
