We’ve said it before, and we’ll say it again: ablative radiation to adrenal mets is tricky. Here is a helpful multi-institutional review of practice patterns for adrenal stereotactic body radiotherapy (SBRT) at three institutions that use either CyberKnife, a standard LINAC, or a MRI-LINAC. It’s a great resource to see how different centers approach adrenal SBRT. The paper includes multiple tables comparing treatment planning guidelines, including dose constraints, and treatment delivery techniques, including respiratory motion management and imaging. Other pearls include planning and treating with an empty stomach for left adrenal treatments, monitoring closely for adrenal insufficiency if treating bilateral mets, and thoughtful consideration on whether to treat at all if pre-treatment renal function is compromised and post-treatment eGFR could fall to <15. Prescriptions spanned a wide range from 8 Gy x 5 to 18 Gy x 3, allowing for a roughly 125% hot spot in tumor and always prioritizing dose constraints above all. | Yu, Pract Radiat Oncol 2024
