Adrenal Metastases and Radiation

Palliative radiotherapy for symptomatic adrenal metastases
Edward M. Soffen, MD. University of Pennsylvania Cancer 1990;65:1318

To evaluate the role of palliative radiotherapy for adrenal metastases, a retrospective review was performed on 16 patients treated between 1972 and 1988 for palliation of symptomatic adrenal metastases. The median patient age was 56 years. In 15 cases lung cancer was the primary site (7 adenocarcinomas, 3 squamous cell carcinomas, 3 large cell carcinomas, and 2 small cell carcinomas) and in 1 case there was an unknown primary (squamous cell carcinoma). Ten of 16 patients were treated with 3000 cGy to opposed anterior and posterior fields (300-cGy fractions [four patients] and 250-cGy fractions [six patients]). The remaining six patients were treated with a variety of techniques, with total doses ranging from 2925 cGy to 4500 cGy. The patients were analyzed for response at their first follow-up visit (2 to 4 weeks after treatment). The overall response rate was 75% (12 of 16 patients). Six patients (38%) had complete pain relief without medication that lasted until death. Two patients had marked pain relief, but still required analgesics. Four patients had marked or moderate pain relief that did not continue through follow-up. Four patients had minimal to no response. All patients were observed until death, with a median survival time after irradiation of 3 months (range, 0.5 to 11 months). Although the prognosis for patients with adrenal metastases is poor, radiotherapy to symptomatic adrenal metastases can be administered with a high probability of achieving effective palliation.

Radiation therapy for adrenal metastases

Nippon Igaku Hoshasen Gakkai Zasshi. 1997 Oct;57(12):801-4.

PURPOSE: To evaluate the role of radiation therapy for adrenal metastases. MATERIALS AND METHODS: Fourteen patients, 13 with primary lung carcinoma and one with primary unknown carcinoma, received radiation therapy for adrenal metastases from 1984 to 1995 at the Hyogo Medical Center for Adults. Total dose ranged from 16 Gy to 60 Gy, and fractional dose from 1.6 Gy/ Fr to 3 Gy/Fr. RESULTS: Partial response of the local tumor was recognized in 2 of 7 patients by CT imaging. Pain relief was obtained in 7 of 8 patients. Median survival was 3 months, and 6-month survival was 28.6% in all patients. Among patients in the symptomatic group, who had complaints of pain due to adrenal mass, survival was even worse (12.5% at 6 months). There were no severe complications, but 4 patients (29%) had gastrointestinal symptoms. CONCLUSION: Radiation therapy is useful for the purpose of pain relief in adrenal metastases.

Radiation therapy for adrenal gland metastases from hepatocellular carcinoma.

Jpn J Clin Oncol. 2005 Feb;35(2):61-7.

BACKGROUND: The adrenal gland is a common site of extrahepatic metastases from hepatocellular carcinoma. However, it has been the subject of few studies, and the optimal treatment remains unclear. Methods previously tried for the management of adrenal gland metastasis of hepatocellular carcinoma included surgical resection, transarterial chemoembolization or percutaneous ethanol injection, on the basis of case reports. External beam radiation therapy has seldom been applied for patients with adrenal gland metastases. METHODS: We retrospectively studied 22 patients with adrenal metastases from hepatocellular carcinoma who were treated with limited-field external beam radiation therapy. The radiation dose to the adrenal lesion ranged from 36 to 54 (median 50) Gy, while the intrahepatic lesions were treated with either surgical resection or transarterial chemoembolization. RESULTS: Among the 14 patients who had pain related to adrenal metastases, 11 (78.6%) had complete pain relief without medication that lasted until death. Two (14.3%) patients had marked pain relief, but still required analgesics. Partial responses were observed in 73% of the patients. The median survival period for all patients was 10 months. No patient died from complications related to adrenal metastasis. Adverse effects were mild. CONCLUSION: Adrenal metastases from hepatocellular carcinoma are sensitive to radiation treatment. Radiation therapy with 50 Gy for adrenal gland metastases is a good palliative therapy with reasonable safety.

Stereotactic Body Radiotherapy for Treatment of Adrenal Metastases.

Chawla S, .Int J Radiat Oncol Biol Phys. 2009 Feb 26.

Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY.

PURPOSE: To investigate the dosimetry and outcomes of patients undergoing stereotactic body radiotherapy (SBRT) for metastases to the adrenal glands. METHODS AND MATERIALS: At the University of Rochester, patients have been undergoing SBRT for limited metastases since 2001. We retrospectively reviewed 30 patients who had undergone SBRT for adrenal metastases from various primary sites, including lung (n = 20), liver (n = 3), breast (n = 3), melanoma (n = 1), pancreas (n = 1), head and neck (n = 1), and unknown primary (n = 1). RESULTS: Of the 30 patients, 14 with five or fewer metastatic lesions (including adrenal) underwent SBRT, with the intent of controlling all known sites of metastatic disease, and 16 underwent SBRT for palliation or prophylactic palliation of bulky adrenal metastases. The prescribed d
ose ranged from 16 Gy in 4 fractions to 50 Gy in 10 fractions. The median dose was 40 Gy. Of the 30 patients, 24 had >3 months of follow-up with serial computed tomography. Of these 24 patients, 1 achieved a complete response, 15 achieved a partial response, 4 had stable disease, and 4 developed progressive disease. No patient developed symptomatic progression of their adrenal metastases. The 1-year survival, local control, and distant control rate was 44%, 55%, and 13%, respectively. No patient developed Radiation Therapy Oncology Group Grade 2 or greater toxicity. CONCLUSION: SBRT for adrenal metastases is well tolerated. Most patients developed widespread metastases shortly after treatment. Local control was poor, although this was a patient population selected for adverse risk factors, such as bulky disease. Additional studies are needed to determine the efficacy of SBRT for oligometastatic adrenal metastases, given the propensity of these patients to develop further disease progression.

Adrenalectomy for solitary adrenal metastases from non-small cell lung cancer.

Pfannschmidt J, Lung Cancer. 2005 Aug;49(2):203-7

BACKGROUND: The treatment of patients with adrenal metastases from lung cancer (non-small cell lung cancer, NSCLC) remains controversial. Several studies of adrenalectomy in cases of isolated adrenal metastases from NSCLC suggest that these patients could have improved survival. Our aim is to define the history of patients after resection of solitary metastases to the adrenal gland and to identify characteristics of patients who achieved prolonged survival. METHODS: Between January 1997 and July 2000, 11 patients underwent curative resection for metastatic NSCLC of the adrenal gland in our institution. In all patients who were accepted for curative adrenalectomy, the primary NSCLC had been treated by complete resection. RESULTS: Eleven patients (seven men and four women) with unilateral adrenal metastases of NSCLC entered the study. Median age was 59 years (range 47-67 years). There was no perioperative death. The overall median survival after metastasectomy was 12.6 months (CI: 9.2-16.1 months). Patients with curative resection and metachronous disease (n=6) had a median survival of 30.9 months and tended to do better than patients with synchronous adrenal metastases (n=5) (median survival: 10.3 months). CONCLUSIONS: We conclude that adrenalectomy for clinically solitary, resectable metastases can be performed safely. It appears reasonable that such selected patients should be considered surgical candidates.