(1) Background: Recent publications foster stereotactic body radiotherapy (SBRT) in patients with adrenal oligometastases or oligoprogression. However, local control (LC) after non-adaptive SBRT shows the potential for improvement. Online adaptive MR-guided SBRT (MRgSBRT) improves tumor coverage and organ-at-risk (OAR) sparing. Long-term results of adaptive MRgSBRT are still sparse. (2) Methods: Adaptive MRgSBRT was performed on a 0.35 T MR-Linac. LC, overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and toxicity were assessed. (3) Results: 35 patients with 40 adrenal metastases were analyzed. The median gross tumor volume was 30.6 cc. The most common regimen was 10 fractions at 5 Gy. The median biologically effective dose (BED10) was 75.0 Gy. Plan adaptation was performed in 98% of all fractions. The median follow-up was 7.9 months. One local failure occurred after 16.6 months, resulting in estimated LC rates of 100% at one year and 90% at two years. ORR was 67.5%. The median OS was 22.4 months, and the median PFS was 5.1 months. No toxicity > CTCAE grade 2 occurred. (4) Conclusions: LC and ORR after adrenal adaptive MRgSBRT were excellent, even in a cohort with comparably large metastases. A BED10of 75 Gy seems sufficient for improved LC in comparison to non-adaptive SBRT.
（1）背景：近期研究支持对肾上腺寡转移或寡进展患者采用立体定向放射治疗（SBRT）。然而，非适应性SBRT后的局部控制（LC）仍有提升空间。在线适应性磁共振引导SBRT（MRgSBRT）可改善肿瘤覆盖范围并减少危及器官（OAR）受照剂量，但其长期疗效数据仍较缺乏。（2）方法：在0.35 T磁共振直线加速器上实施适应性MRgSBRT，评估指标包括LC、总生存期（OS）、无进展生存期（PFS）、总体缓解率（ORR）及毒性反应。（3）结果：共纳入35例患者的40处肾上腺转移灶。肿瘤靶区中位体积为30.6 cc。最常用方案为5 Gy×10次分割，中位生物有效剂量（BED10）为75.0 Gy。98%的治疗分次实施了计划适应性调整。中位随访时间7.9个月，仅1例于16.6个月后出现局部进展，推算1年LC率为100%，2年LC率为90%。ORR达67.5%，中位OS为22.4个月，中位PFS为5.1个月，未出现＞CTCAE 2级的毒性反应。（4）结论：即使在转移灶体积较大的队列中，肾上腺适应性MRgSBRT仍能获得优异的LC与ORR。相较于非适应性SBRT，75 Gy的BED10剂量足以提升局部控制效果。
肿瘤(癌症)患者之家