How do you treat adrenal metastases with SBRT?
Do you treat the whole gland or the lesion only?
What is the role of additional imaging (MRI, PET/CT) to delineate disease?
What expansions do you make for CTV and PTV with fiducials or LINAC w/ 4DCT?
2 Answers
Mednet Member
Radiation Oncology · Vanderbilt-Ingram Cancer Center
Answered on
Adrenal glands move quite a bit with breathing. I would strongly recommend some form of motion management, either with breath hold, or 4DCT with abdominal compression, (the latter of which is my personal preference).
I draw GTV (just tumor, not entire adrenal gland) as defined on whatever imaging sh...
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Mednet Member
Radiation Oncology · Riverside Regional Medical Center
Answered on
Whole gland SBRT with a PTV margin on GTV (we use 5 mm), supine with motion management (LINAC with 4DCT), fuse PET/CT or MRI for tumor delineation, no fiducial markers. In our experience, 36 Gy in 3 fractions works well (Reshko et al., PMID 34277086). Here is a great meta-analysis that shows improve...
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