title: Adrenal metastases in lung cancer: clinical implications of a mathematical model.
abstract: Adrenal gland metastases are common in lung cancer. It is well recognized that aggressive treatment of solitary adrenal metastases leads to improved outcomes but the exact nature of adrenal deposits is not well understood. Controversy exists as to the routing of cancer cells to the adrenal gland with some believing that this transmission is lymphatic, in contrast to the more generally accepted theory of hematogenous spread. Recently published mathematical modeling of cancer progression strongly supports the lymphatic theory. With that in mind, we performed a literature review to look for biological plausibility of simulation results and believe that evidence supports the contention that metastases to the adrenal gland can be routed by means of lymphatic channels. This could explain improved survival for patients in whom solitary adrenal metastases are managed aggressively with surgical or radiation modalities. We are calling for clinical trials prospectively testing this hypothesis.
authors.affiliation: *Division of Hematology Oncology, Department of Medicine, Moore's Cancer Center, University of California San Diego, San Diego, California; †Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California; ‡Department of Mathematics, University of Southern California, Los Angeles, California; §Department of Pathology, Scripps Clinic, La Jolla, California; ‖Division of Oncology and Hematology, Billings Clinic, Billings, Montana; and ¶Department of Cell Biology, The Scripps Research Institute, La Jolla, California.
authors.forename: Lyudmila
authors.initials: L
authors.lastname: Bazhenova
authors.forename: Paul
authors.initials: P
authors.lastname: Newton
authors.forename: Jeremy
authors.initials: J
authors.lastname: Mason
authors.forename: Kelly
authors.initials: K
authors.lastname: Bethel
authors.forename: Jorge
authors.initials: J
authors.lastname: Nieva
authors.forename: Peter
authors.initials: P
authors.lastname: Kuhn
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality* / Q000556:secondary*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology*; D008962:Models, Theoretical; D011379:Prognosis; D015996:Survival Rate
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