title: Radiotherapy for adrenal gland metastases from hepatocellular carcinoma.
abstract: BACKGROUND
  Several studies have found benefits of radiotherapy for adrenal metastasis from hepatocellular carcinoma (HCC). However, the efficacy, safety and outcome issues have not yet been fully addressed. Therefore, we performed this study to further elucidate the feasibility and outcome of radiotherapy in treating adrenal metastasis from HCC.
  
  
  METHODS
  We retrospectively analyzed 81 patients with adrenal metastasis from HCC between 2001 and 2015. Eighteen patients received helical tomotherapy and 63 patients received conventional radiotherapy, including two-dimensional (2-D) or three-dimensional conformal radiotherapy (3-D CRT). The median radiation dose was 50 Gy (range 26-64 Gy) with median fraction size of 2.0 Gy (range 2.0-5.0 Gy). Tumor responses, adverse effects, patient outcomes and prognostic factors were analyzed.
  
  
  RESULTS
  An objective response (complete and partial response) was achieved in 55.6% patients. The helical tomotherapy group showed higher objective response rate than the conventional radiotherapy group (P = 0.031). The major adverse effects were anorexia (51.8%), nausea (41.9%), and fatigue (35.8%). Similar toxicity profile occurred in the 2-D, 3-D CRT and helical tomotherapy groups. The overall survival (OS) rate at 1, 2 and 5 years was 59.9, 35.0, and 12.9%, respectively, with a median survival of 15 months. Patients who received helical tomotherapy achieved a better OS compared to the conventional radiotherapy group (P = 0.047). However, multivariate analysis indicated that radiotherapy technique was not an independent prognostic factor for patient outcome.
  
  
  CONCLUSIONS
  These results suggest that radiotherapy offers a noninvasive approach in controlling adrenal metastasis from HCC with promising local control and acceptable tolerability.
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, No. 180 Feng Lin Road, Shanghai, 200032, China.
authors.forename: B-Y
authors.initials: BY
authors.lastname: Yuan
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, No. 180 Feng Lin Road, Shanghai, 200032, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, No. 180 Feng Lin Road, Shanghai, 200032, China.
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, No. 180 Feng Lin Road, Shanghai, 200032, China.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, No. 180 Feng Lin Road, Shanghai, 200032, China.
authors.forename: Y-Y
authors.initials: YY
authors.lastname: Dong
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, No. 180 Feng Lin Road, Shanghai, 200032, China. zeng.zhaochong@zs-hospital.sh.cn.
authors.forename: Z-C
authors.initials: ZC
authors.lastname: Zeng
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Adrenal metastasis; Hepatocellular carcinoma; Prognosis; Radiotherapy