title: Radiotherapy treatment of adrenal gland metastases from hepatocellular carcinoma: clinical features and prognostic factors.
abstract: BACKGROUND
  The optimal treatment for adrenal metastases from hepatocellular carcinoma (HCC) has not been established. This study analyzed the effects of radiation therapy (RT) for such metastases and identified clinical features and predictors of survival in these patients.
  
  
  METHODS
  We retrospectively investigated 55 patients with adrenal metastasis from HCC who had been treated with RT. Radiation doses to the adrenal lesions ranged from 26 to 60 Gy, while the intrahepatic lesions were treated by surgical resection, transarterial chemoembolization (TACE), liver transplantation, and/or RT. RT was conducted to adrenal lesions after their intrahepatic lesions were controlled more than 2 months. The parameters studied included survival rates and tumor responses to RT. The Kaplan-Meier method was used to evaluate survival rate and the Cox regression model was used to identify potential predictors of outcome.
  
  
  RESULTS
  The patients treated by RT had adrenal metastasis on the right side (41), the left (6), or on both sides (8). In all 55 patients, the median survival duration was 13.6 months and there was 100% pain relief after completion of RT. Adverse effects were mild to moderate. Unfavorable pretreatment predictors determined by univariate analysis were associated with multiple intrahepatic foci, metastases to additional organs, high γ-glutamyltransferase and alpha-fetoprotein levels, liver function of Child-Pugh classification B and uncontrolled primary HCC. By multivariate analysis, unfavorable predictors were multiple intrahepatic foci, metastases to additional organs and uncontrolled primary HCC.
  
  
  CONCLUSIONS
  Radiotherapy as treatment for adrenal metastases in HCC is a good palliative therapy that is associated with reasonable safety. It appears reasonable that such patients should be considered to be treated with radiotherapy. Multiple intrahepatic foci, metastases to additional organs and uncontrolled primary HCC were unfavorable predictors.
authors.forename: Le-Yuan
authors.initials: LY
authors.lastname: Zhou
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai 200032, China. zeng.zhaochong@zs-hospital.sh.cn.
authors.forename: Zhao-Chong
authors.initials: ZC
authors.lastname: Zeng
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Bing
authors.initials: B
authors.lastname: Chen
authors.forename: Sheng-xiang
authors.initials: SX
authors.lastname: Rao
authors.forename: Jian
authors.initials: J
authors.lastname: He
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
authors.forename: Jia-zhou
authors.initials: JZ
authors.lastname: Hou
authors.forename: Zhi-feng
authors.initials: ZF
authors.lastname: Wu
authors.forename: Jian-ying
authors.initials: JY
authors.lastname: Zhang
authors.forename: Yong
authors.initials: Y
authors.lastname: Hu
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis