RESUMO
PURPOSE: The adrenal glands are a common site of metastases because of their rich blood supply. Previously, adrenal metastases were treated with systemic chemotherapy or, more rarely, with surgical resection or palliative radiation therapy. Stereotactic body radiation therapy (SBRT) has recently emerged as an attractive noninvasive approach to definitively treat these lesions. We present our experience in treating adrenal metastases using SBRT and review the current literature. METHODS AND MATERIALS: This is a single-institution retrospective review of patients who received SBRT to adrenal metastases originating from various primary malignancies. Patients who were eligible for SBRT included those with limited metastatic disease (≤5 sites) with otherwise controlled metastatic disease and uncontrolled adrenal metastases. RESULTS: Ten patients met the study's inclusion criteria and received SBRT doses of 30 to 48 Gy in 3 to 5 fractions. Acute sequelae of SBRT treatment included 4 patients with grades 1 or 2 nausea, 3 patients with grade 1 fatigue, and 1 with grade 1 diarrhea. The median follow-up was 6 months with a median overall survival of 9.9 months. One patient demonstrated progressive adrenal gland disease 18.8 months after SBRT treatment. Seven patients developed new distant metastases after treatment, with a median progression-free survival of 3.4 months. Three months after SBRT to the adrenal gland, 1 patient developed a gastrointestinal bleed. CONCLUSIONS: These results complement the limited existing body of literature by demonstrating that SBRT provides good control of treated adrenal gland metastasis; however, high-grade late toxicities may occur. More stringent dose constraint limits may prevent associated serious adverse events.
RESUMO
PURPOSE: Sleep apnea (SA) has been associated with atrial fibrillation (AF) and has been found to be a predictor of AF recurrence after successful pulmonary vein isolation. No investigations have been carried out to determine the prevalence of SA in patients with typical atrial flutter (AFL) and the impact of SA on AFL recurrence after AFL ablation. Our aim is to determine if SA is a predictor of recurrence of AFL and/or atrial arrhythmias in patients who have undergone AFL ablation. METHODS: This study used a retrospective electronic chart review analysis of consecutive right-sided isthmus-dependent AFL referred for ablation over a 2-year period. Recurrent atrial arrhythmias were classified as AFL, AF, or other arrhythmias. SA prevalence was determined. RESULTS: We included 122 consecutive patients undergoing AFL ablation between January 2008 and December 2009. Mean follow-up was 28.3 ± 6.4 months. Males were 75.4%, had a mean age of 68.3 ± 10.4 years, hypertension 65%, and structural heart disease 42%. Prevalence of SA was 27%. Recurrence of AFL was observed in 9.8%, recurrence of AF was observed in 22.1%, and other arrhythmias 4.9%. SA was not a predictor of AFL recurrence (6.1% vs. 11.2%; p = 0.39). SA was neither a predictor of AF nor of other arrhythmia recurrences. Variables associated with AFL recurrence were: no history of preablation antiarrhythmic drugs (18.8% vs. 6.7%; p = 0.04) and lower BMI (27.07 kg/m(2) vs. 30.87 kg/m(2); p = 0.04). CONCLUSIONS: Prevalence of SA in patients with AFL was 27%. SA was not found to be a predictor of AFL recurrence after successful AFL ablation.