How do you treat adrenal metastases with SBRT?

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...

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...