Background: Adrenal metastases are often treated with stereotactic ablative radiation (SAbR). We aimed to assess the incidence, timing, and factors associated with the development of primary adrenal insufficiency (PAI) following SAbR. Methods: A retrospective cohort study comprised 66 consecutive patients (73% men, median age 61 years) who underwent SAbR for adrenal metastasis. Results: The series encompassed metastases from renal cell carcinoma (41%), lung tumors (38%), colorectal adenocarcinoma (9%), melanoma (5%), and others (7%). Median follow-up was 17 months from SAbR. Nine (14%) patients developed PAI at a median of 4.3 months (range, 0.7–20.2). The incidence of PAI was 44% in patients with prior adrenalectomy receiving unilateral SAbR, 44% with bilateral SAbR, 2% with unaffected contralateral gland, and 0% with bilateral metastases treated with unilateral SAbR. PAI was associated with prior adrenalectomy (odds ratio [OR] 32) and bilateral SAbR (OR 8.2), but not age, sex, metastasis size, or biological effective dose. Post-SAbR 6-month and 1-year local control rates were 82% and 75%, respectively. Conclusions: Patients undergoing SAbR for adrenal metastasis are at high risk of developing PAI. PAI is associated with bilateral SAbR and contralateral adrenalectomy. PAI is unlikely with a remaining unaffected adrenal gland or in the setting of bilateral adrenal metastases with unilateral SAbR.
背景：肾上腺转移常采用立体定向消融放疗（SAbR）进行治疗。本研究旨在评估SAbR后原发性肾上腺功能不全（PAI）的发生率、发生时间及相关影响因素。方法：本研究为回顾性队列研究，纳入连续66例因肾上腺转移接受SAbR治疗的患者（男性占73%，中位年龄61岁）。结果：转移瘤来源包括肾细胞癌（41%）、肺部肿瘤（38%）、结直肠腺癌（9%）、黑色素瘤（5%）及其他类型（7%）。自SAbR起中位随访时间为17个月。9例（14%）患者发生PAI，中位发生时间为4.3个月（范围：0.7-20.2个月）。在既往接受肾上腺切除术并接受单侧SAbR的患者中，PAI发生率为44%；双侧SAbR治疗者为44%；对侧肾上腺未受累者为2%；双侧肾上腺转移仅接受单侧SAbR治疗者为0%。PAI与既往肾上腺切除术（比值比[OR] 32）及双侧SAbR（OR 8.2）相关，而与年龄、性别、转移灶大小或生物有效剂量无关。SAbR后6个月和1年的局部控制率分别为82%和75%。结论：因肾上腺转移接受SAbR治疗的患者发生PAI的风险较高。PAI与双侧SAbR及对侧肾上腺切除术相关。当存在未受累的残余肾上腺组织，或双侧肾上腺转移仅接受单侧SAbR治疗时，PAI发生可能性较低。
肿瘤(癌症)患者之家