Radiotherapy for adrenal gland metastases from hepatocellular carcinoma.

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. CONCLUSION: These results suggest that radiotherapy offers a noninvasive approach in controlling adrenal metastasis from HCC with promising local control and acceptable tolerability.

Percutaneous ablation of functioning adenoma in a patient with a single adrenal gland.

The conventional treatment of functioning adrenal adenomas is laparoscopic resection. Since the 1990s, radiofrequency ablation has been increasingly applied to the treatment of tumours of the liver, lungs and musculoskeletal system. However, the use of radiofrequency ablation to treat adrenal nodules is still an uncommon procedure, particularly in aldosterone-producing adenomas. We report the case of a 35-year-old male patient with resistant hypertension, hypokalaemia and aldosterone-producing adenoma in a single adrenal gland. The patient underwent CT-guided percutaneous radiofrequency ablation. Clinical, laboratory and MRI follow-up data indicated excellent response to treatment. This case report is the first in the literature to describe the use of CT-guided percutaneous radiofrequency ablation in the treatment of a functioning adrenal adenoma in a patient with a single adrenal gland.