Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases
Purpose: While dose escalation is associated with improved local control (LC) for adrenal gland metastases (AGMs), the proximity of gastrointestinal (GI) organs-at-risk (OARs) limits the dose that can be safely prescribed via CT-based stereotactic body radiation therapy (SBRT). The advantages of mag...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | Clinical and Translational Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630823001441 |
| _version_ | 1797272396122554368 |
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| author | Matthew Mills Rupesh Kotecha Roberto Herrera Tugce Kutuk Matthew Fahey Evan Wuthrick G. Daniel Grass Sarah Hoffe Jessica Frakes Michael D. Chuong Stephen A. Rosenberg |
| author_facet | Matthew Mills Rupesh Kotecha Roberto Herrera Tugce Kutuk Matthew Fahey Evan Wuthrick G. Daniel Grass Sarah Hoffe Jessica Frakes Michael D. Chuong Stephen A. Rosenberg |
| author_sort | Matthew Mills |
| collection | DOAJ |
| description | Purpose: While dose escalation is associated with improved local control (LC) for adrenal gland metastases (AGMs), the proximity of gastrointestinal (GI) organs-at-risk (OARs) limits the dose that can be safely prescribed via CT-based stereotactic body radiation therapy (SBRT). The advantages of magnetic resonance-guided SBRT (MRgSBRT), including tumor tracking and online plan adaptation, facilitate safe dose escalation. Methods: This is a multi-institutional review of 57 consecutive patients who received MRgSBRT on a 0.35-T MR linac to 61 AGMs from 2019 to 2021. The Kaplan-Meier method was used to estimate overall survival (OS), progression-free survival (PFS), and LC, and the Cox proportional hazards model was utilized for univariate analysis (UVA). Results: Median follow up from MRgSBRT was 16.4 months (range [R]: 1.1–39 months). Median age was 67 years (R: 28–84 years). Primary histologies included non-small cell lung cancer (N = 38), renal cell carcinoma (N = 6), and melanoma (N = 5), amongst others. The median maximum diameter was 2.7 cm (R: 0.6–7.6 cm), and most AGMs were left-sided (N = 32). The median dose was 50 Gy (R: 30–60 Gy) in 5–10 fractions with a median BED10 of 100 Gy (R: 48–132 Gy). 45 cases (74 %) required adaptation for at least 1 fraction (median: 4 fractions, R: 0–10). Left-sided AGMs required adaptation in at least 1 fraction more frequently than right-sided AGMs (88 % vs 59 %, p = 0.018). There were 3 cases of reirradiation, including 60 Gy in 10 fractions (N = 1) and 40 Gy in 5 fractions (N = 2). One-year LC, PFS, and OS were 92 %, 52 %, and 78 %, respectively. On UVA, melanoma histology predicted for inferior 1-year LC (80 % vs 93 %, p = 0.012). There were no instances of grade 3+ toxicity. Conclusions: We demonstrate that MRgSBRT achieves favorable early LC and no grade 3 + toxicity despite prescribing a median BED10 of 100 Gy to targets near GI OARs. |
| first_indexed | 2024-03-07T14:28:42Z |
| format | Article |
| id | doaj.art-08d6139409b2492a89af6d21c30fe33f |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-03-07T14:28:42Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-08d6139409b2492a89af6d21c30fe33f2024-03-06T05:27:43ZengElsevierClinical and Translational Radiation Oncology2405-63082024-03-0145100719Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastasesMatthew Mills0Rupesh Kotecha1Roberto Herrera2Tugce Kutuk3Matthew Fahey4Evan Wuthrick5G. Daniel Grass6Sarah Hoffe7Jessica Frakes8Michael D. Chuong9Stephen A. Rosenberg10Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United StatesDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United StatesDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United StatesDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United StatesUniversity of South Florida Morsani College of Medicine, Tampa, FL, United StatesDepartment of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United StatesDepartment of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United StatesDepartment of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United StatesDepartment of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United StatesDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United StatesDepartment of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States; Corresponding author at: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Dr., Tampa, FL 33612, United States.Purpose: While dose escalation is associated with improved local control (LC) for adrenal gland metastases (AGMs), the proximity of gastrointestinal (GI) organs-at-risk (OARs) limits the dose that can be safely prescribed via CT-based stereotactic body radiation therapy (SBRT). The advantages of magnetic resonance-guided SBRT (MRgSBRT), including tumor tracking and online plan adaptation, facilitate safe dose escalation. Methods: This is a multi-institutional review of 57 consecutive patients who received MRgSBRT on a 0.35-T MR linac to 61 AGMs from 2019 to 2021. The Kaplan-Meier method was used to estimate overall survival (OS), progression-free survival (PFS), and LC, and the Cox proportional hazards model was utilized for univariate analysis (UVA). Results: Median follow up from MRgSBRT was 16.4 months (range [R]: 1.1–39 months). Median age was 67 years (R: 28–84 years). Primary histologies included non-small cell lung cancer (N = 38), renal cell carcinoma (N = 6), and melanoma (N = 5), amongst others. The median maximum diameter was 2.7 cm (R: 0.6–7.6 cm), and most AGMs were left-sided (N = 32). The median dose was 50 Gy (R: 30–60 Gy) in 5–10 fractions with a median BED10 of 100 Gy (R: 48–132 Gy). 45 cases (74 %) required adaptation for at least 1 fraction (median: 4 fractions, R: 0–10). Left-sided AGMs required adaptation in at least 1 fraction more frequently than right-sided AGMs (88 % vs 59 %, p = 0.018). There were 3 cases of reirradiation, including 60 Gy in 10 fractions (N = 1) and 40 Gy in 5 fractions (N = 2). One-year LC, PFS, and OS were 92 %, 52 %, and 78 %, respectively. On UVA, melanoma histology predicted for inferior 1-year LC (80 % vs 93 %, p = 0.012). There were no instances of grade 3+ toxicity. Conclusions: We demonstrate that MRgSBRT achieves favorable early LC and no grade 3 + toxicity despite prescribing a median BED10 of 100 Gy to targets near GI OARs.http://www.sciencedirect.com/science/article/pii/S2405630823001441Adrenal gland metastasisStereotactic body radiation therapyMR-guided radiation therapyOligometastasis |
| spellingShingle | Matthew Mills Rupesh Kotecha Roberto Herrera Tugce Kutuk Matthew Fahey Evan Wuthrick G. Daniel Grass Sarah Hoffe Jessica Frakes Michael D. Chuong Stephen A. Rosenberg Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases Clinical and Translational Radiation Oncology Adrenal gland metastasis Stereotactic body radiation therapy MR-guided radiation therapy Oligometastasis |
| title | Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases |
| title_full | Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases |
| title_fullStr | Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases |
| title_full_unstemmed | Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases |
| title_short | Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases |
| title_sort | multi institutional experience of mr guided stereotactic body radiation therapy for adrenal gland metastases |
| topic | Adrenal gland metastasis Stereotactic body radiation therapy MR-guided radiation therapy Oligometastasis |
| url | http://www.sciencedirect.com/science/article/pii/S2405630823001441 |
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