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Buergy, D.* ; Würschmidt, F.* ; Gkika, E.* ; Hörner-Rieber, J.* ; Knippen, S.* ; Gerum, S.* ; Balermpas, P.* ; Henkenberens, C.* ; Voglhuber, T.* ; Kornhuber, C.* ; Barczyk, S.* ; Röper, B.* ; Rashid, A.* ; Blanck, O.* ; Wittig, A.* ; Herold, H.U.* ; Brunner, T.B.* ; Klement, R.J.* ; Kahl, K.H.* ; Ciernik, I.F.* ; Ottinger, A.* ; Izaguirre, V.* ; Putz, F.* ; König, L.M.* ; Hoffmann, M.* ; Combs, S.E. ; Guckenberger, M.* ; Boda-Heggemann, J.*

Stereotactic or conformal radiotherapy for adrenal metastases - patient characteristics and outcomes in a multicenter analysis.

Int. J. Cancer 149, 358-370 (2021)

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To report outcome (freedom from local progression: FFLP, overall survival: OS, and toxicity) after stereotactic, palliative, or highly conformal fractionated (> 12) radiotherapy (SBRT, Pall-RT, 3DCRT/IMRT) for adrenal metastases in a retrospective multicenter cohort within the framework of the German Society for Radiation Oncology (DEGRO). Adrenal metastases treated with SBRT (≤ 12 fractions, biologically effective dose, (BED10) ≥ 50 Gy), 3DCRT/IMRT (> 12 fractions, BED10 ≥ 50 Gy) or Pall-RT (BED10 < 50 Gy) were eligible for this analysis. In addition to unadjusted FFLP (Kaplan-Meier/Log-rank), we calculated the competing-risk-adjusted local recurrence rate (CRA-LRR). 326 patients with 366 metastases were included by 21 centers (median follow-up: 11.7 months). Treatment was SBRT, 3DCRT/IMRT, and Pall-RT in 260, 27, and 79 cases, respectively. Most frequent primary tumors were non-small-cell lung cancer (NSCLC; 52.5%), SCLC (16.3%), and melanoma (6.7%). Unadjusted FFLP was higher after SBRT v. Pall-RT (p = 0.026) while numerical differences in CRA-LRR between groups did not reach statistical significance (1-year CRA-LRR: 13.8%, 17.4%, and 27.7%). OS was longer after SBRT v. other groups (p < 0.05) and increased in patients with locally-controlled metastases in a landmark analysis (p < 0.0001). Toxicity was mostly mild; notably, 4 cases of adrenal insufficiency occurred, 2 of which were likely caused by immunotherapy or tumor progression. RT for adrenal metastases was associated with a mild toxicity profile in all groups and a favorable 1-year CRA-LRR after SBRT or 3DCRT/IMRT. 1-year FFLP was associated with longer OS. Dose-response analyses for the dataset are underway.

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