The Study Of Clinical Efficacy Of Stereotactic Gamma-ray Body Radiation Therapy For Adrenal Gland Metastases

Objective: To assess therapeutic outcomes and toxicity of gamma-knife in the treatment of adrenal metastases,and analyse the influence factors of efficacy and prognosis in adrenal metastases.Methods: From January 2008 to January 2014, the research analyzed 32 patients with adrenal metastatic carcinoma from the Air Force General hospital performed withγ-knife treatment retrospectively. Age was from 42 to 80(median 64).There were 23 men and 9 women, the KPS of them were greater than or equal to 70.The primary tumor types were lung cancer(20 cases),and 12 cases in other cancer.The maximum diameter of tumor was 1.5-8.7cm(median 4.0cm).A total dose sent 3- 5 Gy/ fraction to 50%isodose covering 100% PTV, 70% isodose covering 90% GTV,five times per week.the radiation dose to adrenal nidus ranged from 40 to 52 Gy,the median dose was 48 Gy,and biological effective dose(BED) of 56.0-75.0Gy(median 66.4Gy).The recent effect was evaluated with RECIST,adverse reactions were assessed with RTOG.We used SPSS statistical software to evaluate the data, all patients data were analyzed by Kaplan-Meier and log-rank method,the multiple factors were analyzed by Cox regression analyses.We set statistical significance with P<0.05.Result: There were 38 lesions.The local lesions response rate was86.84%(33/38),with complete remission rate was 36.84%(14/38),and partial was50.00%(19/38).Local control rate of 1-year,2-year and 3-year were 100%(21/21)、90.91%(10/11)、83.33%(5/6).The overall survival rate of 1-year,2-year and 3-year were 61.29%(19/31)、31.03%(9/29)、17.24%(5/29).8 cases had back pain, 3patients had complete relief of pain, 4 petients had pain relief,the pain relief rate was87.5%.The majority of radioreactions were Grades 1 to 2 toxicities, only 1 case of level III gastrointestinal reaction and 2 cases of grade III hematology adverse effects appeared.Conclusion: Gamma knife treatment has yielded good curative effect on adrenal metastatic carcinoma. Radiotherapy dose mode with 3 to 5Gy/time,40 to 52Gy/times, 5times/week at 50% isodose line is safe and effective to treating local tumors.In the results of cox multiplicity analysis,primary tumor control and metachronous metastases retain their independent significance in prognosis of adrenal metastatic carcinoma.