Novel Dose Escalation Approaches for Stereotactic Body Radiotherapy to Adrenal Oligometastases: A Single-Institution Experience.
Adrenal Gland Neoplasms
/ radiotherapy
Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung
/ radiotherapy
Carcinoma, Renal Cell
/ radiotherapy
Disease-Free Survival
Female
Humans
Kidney Neoplasms
/ pathology
Lung Neoplasms
/ pathology
Male
Middle Aged
Proportional Hazards Models
Radiosurgery
/ methods
Radiotherapy Dosage
Retrospective Studies
Small Cell Lung Carcinoma
/ radiotherapy
Journal
American journal of clinical oncology
ISSN: 1537-453X
Titre abrégé: Am J Clin Oncol
Pays: United States
ID NLM: 8207754
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
pubmed:
26
11
2019
medline:
7
5
2020
entrez:
26
11
2019
Statut:
ppublish
Résumé
The role of local disease control in the oligometastatic setting is evolving. Stereotactic body radiation therapy (SBRT) is a noninvasive treatment option for oligometastases; however, using ablative radiation doses for adrenal metastases raises concern given the proximity to radiosensitive organs. Novel treatment techniques may allow for selective dose escalation to improve local control (LC) while minimizing dose to nearby critical structures. We retrospectively reviewed patients with adrenal oligometastases treated with SBRT from 2013 to 2018. LC, disease-free survival, and overall survival were estimated using Kaplan-Meier methods. Predictors of outcomes were evaluated by log-rank and Cox proportional hazard analyses. We identified 45 adrenal oligometastases in 41 patients treated with SBRT. The median age at treatment was 67 years (range, 40 to 80). The most common primary histologies were non-small cell lung cancer (51%), renal cell carcinoma (24%), and small cell lung cancer (10%). The median prescription dose was 50 Gy (range, 25 to 60 Gy), with 30 (67%) lesions receiving ≥50 Gy and 14 (31%) receiving 60 Gy. In total, 26 (58%) lesions received a simultaneous-integrated boost. Of the 42 treatment simulations, 26 (62%) were supine, 5 (12%) prone, and 11 (26%) in the left lateral decubitus position. At a median follow-up of 10.5 months, there were 3 local failures with a 12-month LC rate of 96%. Adrenal SBRT for oligometastatic disease is a feasible, noninvasive option with excellent LC and minimal toxicity. Lesions in close proximity to radiosensitive organs may benefit from dynamic patient positioning and selective simultaneous-integrated boost techniques to allow for dose escalation, while also limiting toxicity risks.
Identifiants
pubmed: 31764023
doi: 10.1097/COC.0000000000000634
pii: 00000421-202002000-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
107-114Références
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