title: Radiation therapy for adrenal gland metastases from hepatocellular carcinoma.
abstract: BACKGROUND
  The adrenal gland is a common site of extrahepatic metastases from hepatocellular carcinoma. However, it has been the subject of few studies, and the optimal treatment remains unclear. Methods previously tried for the management of adrenal gland metastasis of hepatocellular carcinoma included surgical resection, transarterial chemoembolization or percutaneous ethanol injection, on the basis of case reports. External beam radiation therapy has seldom been applied for patients with adrenal gland metastases.
  
  
  METHODS
  We retrospectively studied 22 patients with adrenal metastases from hepatocellular carcinoma who were treated with limited-field external beam radiation therapy. The radiation dose to the adrenal lesion ranged from 36 to 54 (median 50) Gy, while the intrahepatic lesions were treated with either surgical resection or transarterial chemoembolization.
  
  
  RESULTS
  Among the 14 patients who had pain related to adrenal metastases, 11 (78.6%) had complete pain relief without medication that lasted until death. Two (14.3%) patients had marked pain relief, but still required analgesics. Partial responses were observed in 73% of the patients. The median survival period for all patients was 10 months. No patient died from complications related to adrenal metastasis. Adverse effects were mild.
  
  
  CONCLUSIONS
  Adrenal metastases from hepatocellular carcinoma are sensitive to radiation treatment. Radiation therapy with 50 Gy for adrenal gland metastases is a good palliative therapy with reasonable safety.
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China. zczeng@zshospital.net
authors.forename: Zhao-Chong
authors.initials: ZC
authors.lastname: Zeng
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.forename: Lun-Xiu
authors.initials: LX
authors.lastname: Qin
authors.forename: Shen-Long
authors.initials: SL
authors.lastname: Ye
authors.forename: Hui-Chuan
authors.initials: HC
authors.lastname: Sun
authors.forename: Bin-Liang
authors.initials: BL
authors.lastname: Wang
authors.forename: Jian-Ying
authors.initials: JY
authors.lastname: Zhang
authors.forename: Yao
authors.initials: Y
authors.lastname: Yu
authors.forename: Jie-Min
authors.initials: JM
authors.lastname: Cheng
authors.forename: Xiao-Lin
authors.initials: XL
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate