Stereotactic Body Radiation Therapy (SBRT) for adrenal metastases

Purpose:To compare advanced treatment techniques with photons and protons as a stereotactic body radiation therapy (SBRT) for adrenal glands metastases.Materials and Methods:Planning computer tomographic (CT) scans of 10 patients were selected. A total dose of 45 Gy in 7.5 Gy fractions was prescribed. Organs at risk (OAR) were liver and kidneys. Dose–volume metrics were defined to quantify quality of plans assessing target coverage and sparing of organs at risk. Plans for RapidArc, intensity-modulated radiotherapy (IMRT), dynamic conformal arcs, 3D conformal static fields, and intensity modulated protons were compared. The main planning objective for the clinical target volume (CTV) was to cover 100% of the volume with 95% (V95% = 100%) and to keep the maximum dose below 107% of the prescribed dose (V107% = 0%). Planning objective for planning target volume (PTV) was V95% > 80%. For kidneys, the general planning objective was V15Gy < 35% and for liver V15Gy < (liver volume–700 cm3).Results:All techniques achieved the minimum and maximum dose objective for CTV and PTV, D5–95% ranged from 1 Gy (protons) to 1.6 Gy (conformal static fields) on CTV. Maximal organ at risk sparing was achieved by protons. RapidArc presented the second lowest dose bath (V10Gy and integral dose) after protons and the best conformality together with IMRT.Conclusions:Stereotactic body radiation therapy (SBRT) to adrenal glands metastases is achievable with several advanced techniques with either photons or protons. The intensity modulated approaches using either static fields, dynamic arcs or protons are superior to the other conformal solutions. For their simplicity, IMRT or RapidArc should be considered as the first option radiation treatment for those patients not eligible for proton treatment.Ziel:Diese Studie vergleicht fortgeschrittene Bestrahlungstechniken mit Photonen und Protonen bei der stereotaktischen Körperbestrahlung von Metastasen in Nebennieren.Material und Methodik:Es wurden Planungs-CTs von 10 Patienten ausgewählt und eine Dosis von 45 Gy mit einer Fraktionierungsdosis von 7.5 Gy verschrieben. Die Leber und die Nieren wurden als kritische Organe eingezeichnet. Es wurde eine Dosis-Volumen-Metrik zur Quantifizierung der Planqualität in Bezug auf die Zielvolumenabdeckung und die Schonung der kritischen Organe erstellt. RapidArc-, IMRT-, dynamisch konformale Rotations-, 3D konformale Pläne und intensitätsmodulierte Protonenpläne wurden verglichen. Die Planungsvorgaben für das CTV war die 100%ige Abdeckung des Volumens mit 95% der Verschreibungsdosis (V95% = 100%) und die Einhaltung einer maximalen Dosis unterhalb von 107% der Verschreibungsdosis (V107% = 0%). Die Planungsvorgabe für das PTV war V95% > 80%., für die Nieren V15Gy < 35% und für die Leber V15Gy < (Lebervolumen–700 cm3).Ergebnisse:Alle Bestrahlungstechniken erfüllten die minimalen und maximalen Dosisvorgaben für das CTV und das PTV.D5–95% reichten von 1 Gy (Protonen) bis zu 1,6 Gy (konformale statische Felder) beim CTV. Die maximale Schonung der kritischen Organe wurde mit der Protonentechnik erzielt. Die RapidArc-Technik zeigte das zweitniedrigste Dosisbad (V10Gy und integrale Dosis) nach den Protonen und die beste Konformität zusammen mit der IMRT-Technik.Schlussfolgerung:Die stereotaktische Körperbestrahlungstherapie von Metastasen in Nebennieren ist mit mehreren fortgeschrittenen Bestrahlungstechniken mit Photonen oder Protonen durchführbar. Die intensitätsmodulierten Methoden, entweder mit statischen Einstrahlrichtungen, dynamischen Rotationen oder Protonen, sind den anderen konformalen Techniken überlegen. Dank ihrer Einfachheit sollte die IMRT- oder die RapidArc-Technik als erste Option bei der Bestrahlung von Patienten, welche für eine Protonenbehandlung nicht in Frage kommen, berücksichtigt werden.

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