Stereotactic body radiotherapy of adrenal metastases-A dose-finding study

Buergy D, Wuerschmidt F, Gkika E, Hoerner-Rieber J, Knippen S, Gerum S, Balermpas P, Henkenberens C, Voglhuber T, Kornhuber C, Barczyk S, Roeper B, Rashid A, Blanck O, Wittig A, Herold HU, Brunner TB, Sweeney RA, Kahl KH, Ciernik IF, Ottinger A, Izaguirre V, Putz F, Koenig L, Hoffmann M, Combs SE, Guckenberger M, Boda-Heggemann J (2022)

Publication Type: Journal article

Publication year: 2022

Journal

DOI: 10.1002/ijc.34017

Abstract

Optimal doses for the treatment of adrenal metastases with stereotactic radiotherapy (SBRT) are unknown. We aimed to identify dose-volume cut-points associated with decreased local recurrence rates (LRR). A multicenter database of patients with adrenal metastases of any histology treated with SBRT (biologically effective dose, BED10 >= 50 Gy, <= 12 fractions) was analyzed. Details on dose-volume parameters were required (planning target volume: PTV-D98%, PTV-D50%, PTV-D2%; gross tumor volume: GTV-D50%, GTV-mean). Cut-points for LRR were optimized using the R maxstat package. One hundred and ninety-six patients with 218 lesions were included, the largest histopathological subgroup was adenocarcinoma (n = 101). Cut-point optimization resulted in significant cut-points for PTV-D50% (BED10: 73.2 Gy; P = .003), GTV-D50% (BED10: 74.2 Gy; P = .006), GTV-mean (BED10: 73.0 Gy; P = .007), and PTV-D2% (BED10: 78.0 Gy; P = .02) but not for the PTV-D98% (P = .06). Differences in LRR were clinically relevant (LRR >= doubled for cut-points that were not achieved). Further dose-escalation was not associated with further improved LRR. PTV-D50%, GTV-D50%, and GTV-mean cut-points were also associated with significantly improved LRR in the adenocarcinoma subgroup. Separate dose optimizations indicated a lower cut-point for the PTV-D50% (BED10: 69.1 Gy) in adenocarcinoma lesions, other values were similar (<2% difference). Associations of cut-points with overall survival (OS) and progression-free survival were not significant but durable freedom from local recurrence was associated with OS in a landmark model (P < .001). To achieve a significant improvement of LRR for adrenal SBRT, a moderate escalation of PTV-D50% BED10 >73.2 Gy (adenocarcinoma: 69.1 Gy) should be considered.

Authors with CRIS profile

Involved external institutions

Radiologische Allianz GbR Germany (DE) University of Zurich / Universität Zürich (UZH) Switzerland (CH) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Klinikum Westmünsterland GmbH Germany (DE) Universitätsklinikum Freiburg Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Universitätsklinikum Jena Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) Technische Universität München (TUM) Germany (DE) Universitätsklinikum Halle (Saale) Germany (DE) MEDICLIN Robert Janker Klinik Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) CyberKnife Centrum Mitteldeutschland GmbH Germany (DE) Universitätsklinikum Magdeburg A.ö.R. Germany (DE) Leopoldina Krankenhaus Schweinfurt Germany (DE) Klinikum Augsburg Germany (DE) Medizinische Hochschule Brandenburg "Theodor Fontane" / Brandenburg Medical School "Theodor Fontane" Germany (DE) Klinikum Darmstadt Germany (DE) Ruprecht-Karls-Universität Heidelberg Germany (DE)

How to cite

APA:

Buergy, D., Wuerschmidt, F., Gkika, E., Hoerner-Rieber, J., Knippen, S., Gerum, S.,... Boda-Heggemann, J. (2022). Stereotactic body radiotherapy of adrenal metastases-A dose-finding study. International Journal of Cancer. https://doi.org/10.1002/ijc.34017

MLA:

Buergy, Daniel, et al. "Stereotactic body radiotherapy of adrenal metastases-A dose-finding study." International Journal of Cancer (2022).

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