A Single-Institution Experience in Image-Guided Thermal Ablation of Adrenal Gland Metastases

doi:10.1016/j.jvir.2013.12.013

Journal of Vascular and Interventional Radiology

Volume 25, Issue 4, April 2014, Pages 593-598

https://doi.org/10.1016/j.jvir.2013.12.013 Get rights and content

Abstract

Purpose

To assess safety, technical success, local control, and survival associated with percutaneous image-guided adrenal ablation.

Materials and Methods

Adult patients with adrenal metastases who underwent percutaneous image-guided adrenal ablation during the years 2003–2012 were identified. There were 32 patients with 37 adrenal tumors identified. Technical success, safety, local control, and survival were analyzed according to standard criteria.

Results

In 32 patients (25 men and 7 women; mean age, 66 y; age range, 44–88 y) with 37 adrenal tumors, 35 ablation procedures were performed. One patient with an 8.2-cm tumor underwent planned cryoablation debulking fully anticipating untreated margins owing to close proximity of the pancreas (ie, the intent was to diminish tumor burden rather than a curative intervention). Of the 36 patients treated with curative intent, technical success was achieved in 35 (97%) tumors. Follow-up imaging was performed on 34 of 37 tumors (excluding patients with intentional debulking [n = 1], technical failure [n = 1], and absence of follow-up [n = 1]). Local recurrence developed in 3 (8.8%) of 34 tumors. Local tumor control was achieved in 31 lesions at a mean of 22.7 months of follow-up. Recurrence-free survival and overall survival at 36 months were 88% and 52%, respectively, with a median survival of 34.5 months. A Common Terminology Criteria for Adverse Events version 4 grade 3 or 4 complication was observed in three (8.6%) ablation procedures.

Conclusions

Image-guided ablation is safe and effective for local control of metastatic adrenal tumors and provides a minimally invasive alternative to surgical resection in appropriately selected patients.

Section snippets

Materials And Methods

This retrospective review was compliant with the Health Insurance Portability and Accountability Act and approved by our institutional review board. The patient population comprised adults with adrenal metastases who underwent percutaneous image-guided adrenal ablation during the period 2003–2012. The population included 12 patients from a prior published series (15). Presence of pheochromocytoma was excluded via measurement of plasma fractionated metanephrines or 24-hour urinary total and

Index Tumor Details

Adrenal metastases ranged in size from 0.8–8.2 cm (mean, 3.0 cm). There were 19 tumors in the left adrenal gland and 18 in the right. Histology of the treated metastases included renal cell carcinoma (n = 16; 43%), melanoma (n = 7; 19%), and colorectal cancer (n = 4; 11%). Additional primary histologies included hepatocellular carcinoma (n = 2; 5%), non–small cell lung carcinoma (n = 2; 5%), lung adenocarcinoma, squamous cell lung carcinoma, neuroendocrine tumor of the lung, urothelial

Discussion

Image-guided ablation has developed into a promising method of local tumor therapy in patients unable or unwilling to undergo surgical resection. Wolf et al (14) demonstrated favorable oncologic outcomes in 22 patients treated with RF and microwave ablation, including 83% local recurrence-free survival at mean 45 months of follow-up. Li et al (22) used microwave ablation to treat 9 of 10 malignant adrenal tumors after a single session. Our data suggest that adrenal ablation for metastatic

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Cited by (41)

Challenges and controversies in adrenal surgery: A practical approach
2023, Current Problems in Surgery
Percutaneous Image-Guided Thermal Ablation of Adrenal Metastasis from Melanoma: A Single-Institution Experience
2021, Journal of Vascular and Interventional Radiology
The outcomes of technically successful image-guided percutaneous thermal ablation of melanoma adrenal metastases involving 11 tumors in 9 consecutive patients over 12 years (2009–2020) were evaluated. All patients had multiple treated metastatic sites, and 44.4% (4/9) had greater than 5 metastatic sites. The mean maximal tumor diameter was 3.6 ± 1.6 cm. The local recurrence-free survival at 1 year was 85.7%. With a median survival of 19.4 months, 66.6% (6/9) of patients died from tumor progression. The 1- and 3-year overall survival rate was 60.0% and 30.0%, respectively. All patients were pretreated with alpha-adrenergic blockade, and 36% (4/11) developed a hypertensive crisis. The median hospital length of stay was 1 day (range, 1–2 days), without any major complications. Thermal ablation of adrenal metastasis from a melanoma provides acceptable local control and a good safety profile.
Image-Guided Percutaneous Ablation of Adrenal Metastases: A Meta-Analysis of Efficacy and Safety
2021, Journal of Vascular and Interventional Radiology
Citation Excerpt :
Compared with RF, MWA is able to achieve higher temperatures with shorter ablation times, and so it is postulated that the rapid increase in temperature in MWA increases the risk of hypertensive crisis during adrenal gland ablation (35,53,54). Finally, invasive blood pressure monitoring via an arterial line is more sensitive for hypertensive episodes and may be warranted for patients at higher risk for morbidity from these events (25,27). There are a number of limitations to this study.
To evaluate the efficacy and safety of percutaneous ablation of adrenal metastases through a meta-analysis of various image-guided percutaneous ablation techniques.
A comprehensive literature search of PubMed and Embase databases was performed for studies evaluating the efficacy and/or safety of image-guided percutaneous ablation of adrenal metastases. A total of 37 studies published between 2009 and 2020 were analyzed, comprising a sample size of 959 patients. Proportion estimates of overall survival, local control, and toxicity were analyzed in a pooled meta-analysis. The pooled prevalence of adverse events after ablation was calculated based on common terminology criteria for adverse events (CTCAE) grading.
Of the 959 included patients, 320 (33.3%) underwent radiofrequency ablation, 72 (7.5%) microwave ablation, 95 (9.9%) cryoablation, and 46 (4.8%) ethanol injections for treatment of adrenal metastases. The remaining 426 (44.4%) patients were from studies involving a mixture of the 4 listed percutaneous ablation techniques. The pooled 1-year local control rate was 80% (95% confidence interval [CI], 76%–83%). The pooled 1-year overall survival rate was 77% (95% CI, 70%–83%). The overall rate of severe adverse events after ablation (CTCAE grade 3 or higher) was 16.1%. The overall rate of low-grade adverse events after ablation (CTCAE grade 2 or lower) was 32.6%. Approximately 21.9% (n = 203) of patients experienced intraprocedural hypertensive crises, the majority of which were reversed with antihypertensive medications.
This study demonstrates that image-guided percutaneous ablation can be effective in achieving acceptable short- to mid-term local tumor control and overall survival with a moderate safety profile.
Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters
2019, Journal of Vascular and Interventional Radiology
Citation Excerpt :
Thermal ablation is used for treating adrenal tumors for several decades and is gaining increasing clinical attention. However, a great proportion of studies have largely focused on the treatment of adrenal metastasis (15–19). In the 5 studies that reported resolution or improvement of HTN, the percentage of patients experiencing resolution or improvement of HTN was 75.3% (58 of 77 patients), and 19 patients reported unchanged or worse HTN postablation.
To assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma.
A systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated.
A total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (−29.06 mm Hg; 95% confidence interval [CI], −33.93 to −24.19), DBP (−16.03 mm Hg; 95% CI, −18.33 to −13.73), and the number of antihypertensive medications used (−1.43; 95% CI, −1.97 to −0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration.
Thermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.
Stereotactic body radiation therapy for adrenal gland metastases: Outcomes and toxicity
2018, Advances in Radiation Oncology
Citation Excerpt :
For clinically appropriate, oligometastatic patients with adrenal metastases, open or laparoscopic adrenalectomy remains the standard of care and offers long-term (≥5 years) overall survival (OS) rates that range between 22% and 45%.12-23 Percutaneous ablative procedures such as microwave and radiofrequency ablation are also frequently used, and several retrospective series have reported 3-year OS rates >50%.24-32 A noninvasive, ablative modality called stereotactic body radiation therapy (SBRT; also referred to as stereotactic ablative radiation therapy) has emerged as a promising alternative option for the local treatment of oligometastatic disease.33-35
This study aimed to report on our institutional experience in the use of stereotactic body radiation therapy (SBRT) for the treatment of adrenal gland metastases. Specifically, we examined the outcomes and toxicity from this treatment modality on adjacent organs at risk.
Data were retrieved from patients with adrenal metastases who were treated with SBRT between 2008 and 2017. Patients with primary adrenal malignancies were excluded. Toxicities were graded in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Time-to-event rates were calculated from the date of SBRT delivery.
In total, 35 patients with adrenal metastases were identified. Four patients were treated for bilateral disease. The median dose was 40 Gy (range, 20-54 Gy) in 5 fractions (range, 1-6 fractions). The median follow-up time was 37 months (range, 14-451 months) from disease diagnosis and 7 months (range, 1-54 months) from the SBRT start date. With death treated as a competing risk event, the cumulative incidence of local failure was 7.6% at 1 year after SBRT and 19.2% at 3 years. The median overall survival (OS) time was 19 months (95% confidence interval, 8-54 months) and tumor size correlated with survival (P = .0006). Patients with metastases <2.9 cm had a median OS of 54 months compared with 11 months for those with adrenal metastases ≥2.9 cm (P = .01). Incidence of grade 2 toxicity was 17% with no case of grade ≥3 toxicity. SBRT did not impact renal function with a mean estimated decline in glomerular filtration rate of only 2.6 ± 8 mL/min/1.73 m² compared with baseline. Combined kidneys V5 and combined renal cortex V17.5 did not correlate with a change in estimated glomerular filtration rate (P = .7 and P = .9, respectively).
SBRT offers excellent local control for the treatment of adrenal gland metastases with very low toxicity rates and no significant short-term impact on renal function.
Adrenal Metastasectomy in the Era of Immuno- and Targeted Therapy
2023, Annals of Surgical Oncology

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: None of the authors have identified a conflict of interest.

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Clinical StudyA Single-Institution Experience in Image-Guided Thermal Ablation of Adrenal Gland Metastases

Abstract

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Materials And Methods

Index Tumor Details

Discussion

Eur J Surg Oncol

J Vasc Interv Radiol

Eur J Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

Ablation of adrenal neoplasms

Abdom Imaging

Image-guided adrenal tumor ablation

AJR Am J Roentgenol

Adrenalectomy for isolated adrenal metastases from non-adrenal cancer

Int J Oncol

Adrenalectomy for metastatic disease to the adrenal glands

Br J Surg

Clinical Study
A Single-Institution Experience in Image-Guided Thermal Ablation of Adrenal Gland Metastases