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Titel:

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

Dokumenttyp:
Journal Article
Autor(en):
Buergy, Daniel; Würschmidt, Florian; Gkika, Eleni; Hörner-Rieber, Juliane; Knippen, Stefan; Gerum, Sabine; Balermpas, Panagiotis; Henkenberens, Christoph; Voglhuber, Theresa; Kornhuber, Christine; Barczyk, Steffen; Röper, Barbara; Rashid, Ali; Blanck, Oliver; Wittig, Andrea; Herold, Hans-Ulrich; Brunner, Thomas Baptist; Sweeney, Reinhart A; Kahl, Klaus Henning; Ciernik, Ilja Frank; Ottinger, Annette; Izaguirre, Victor; Putz, Florian; König, Laila; Hoffmann, Michael; Combs, Stephanie Elisabeth; G...     »
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.
Zeitschriftentitel:
Int J Cancer
Jahr:
2022
Band / Volume:
151
Heft / Issue:
3
Seitenangaben Beitrag:
412-421
Volltext / DOI:
doi:10.1002/ijc.34017
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/35383919
Print-ISSN:
0020-7136
TUM Einrichtung:
Klinik und Poliklinik für RadioOnkologie und Strahlentherapie
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