Efficacy of stereotactic body radiotherapy in hepatocellular carcinoma with adrenal metastases: a retrospective analysis.

[BACKGROUND] Hepatocellular carcinoma (HCC) with adrenal metastasis is associated with poor prognosis and lacks standardized treatment strategies. Stereotactic body radiotherapy (SBRT) is a promising non-invasive option, yet its efficacy in this setting remains underexplored. This study aims to evaluate the efficacy and safety of SBRT in managing HCC patients with adrenal metastasis, focusing on factors influencing local control (LC) and overall survival (OS).

[METHODS] This retrospective study included 52 HCC patients with adrenal metastases treated with SBRT using the CyberKnife system between February 2016 and March 2022. Gross tumor volume (GTV) and biologically effective dose (BED) were calculated, and LC and OS were analyzed. Prognostic factors were assessed using univariate and multivariate Cox regression.

[RESULTS] At a median follow-up of 12.5 months, the overall response rate was 86.0%, with LC rates of 100%, 81.7%, and 75.8% at 6 months, 1 year, and 2 years, respectively. The median OS was 22 months. Intrahepatic tumor control and absence of extra-organ metastases were independently associated with improved OS (P=0.01 and P=0.001, respectively). No grade ≥2 adverse reactions were observed.

[CONCLUSIONS] CyberKnife-based SBRT provides high LC rates and acceptable survival outcomes in HCC patients with adrenal metastases. Intrahepatic lesion control and extrahepatic disease burden are key factors influencing prognosis. SBRT should be considered as a local treatment strategy in multidisciplinary management of this population.