Re-irradiation of adrenal metastases using MR-guided adaptive SABR: A feasible and effective approach in a high-risk population

Miguel A. Palacios; Anna M. E. Bruynzeel; Peter S. N. van Rossum; Omar Bohoudi; Suresh Senan; Famke L. Schneiders

doi:10.1016/j.ctro.2025.101056

Re-irradiation of adrenal metastases using MR-guided adaptive SABR: A feasible and effective approach in a high-risk population

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Abstract

Re-irradiation of adrenal metastases is challenging due to cumulative dose constraints. We present seven patients treated with MR-guided adaptive stereotactic ablative radiotherapy (SABR), leveraging real-time imaging and on-table adaptation for precise dose delivery (5× 10 Gy or 3× 15 Gy). This first report of ablative-dose MR-guided SABR in re-irradiation demonstrates excellent local control and acceptable toxicity, with six patients progression-free at median 8.6 months and no grade ≥3 events (one grade 2 vertebral fracture, one grade 1 nausea). By providing a non-invasive alternative to surgery or palliative radiotherapy, MR-guided adaptive SABR expands therapeutic options for high-risk patients.

Original language	English
Article number	101056
Journal	Clinical and Translational Radiation Oncology
Volume	56
DOIs	https://doi.org/10.1016/j.ctro.2025.101056
Publication status	Published - 1 Jan 2026

Keywords

Adrenal metastasis
MR linac
Oligometastasis
Re-irradiation
SABR

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title = "Re-irradiation of adrenal metastases using MR-guided adaptive SABR: A feasible and effective approach in a high-risk population",

abstract = "Re-irradiation of adrenal metastases is challenging due to cumulative dose constraints. We present seven patients treated with MR-guided adaptive stereotactic ablative radiotherapy (SABR), leveraging real-time imaging and on-table adaptation for precise dose delivery (5× 10 Gy or 3× 15 Gy). This first report of ablative-dose MR-guided SABR in re-irradiation demonstrates excellent local control and acceptable toxicity, with six patients progression-free at median 8.6 months and no grade ≥3 events (one grade 2 vertebral fracture, one grade 1 nausea). By providing a non-invasive alternative to surgery or palliative radiotherapy, MR-guided adaptive SABR expands therapeutic options for high-risk patients.",

keywords = "Adrenal metastasis, MR linac, Oligometastasis, Re-irradiation, SABR",

author = "Palacios, \{Miguel A.\} and Bruynzeel, \{Anna M. E.\} and \{van Rossum\}, \{Peter S. N.\} and Omar Bohoudi and Suresh Senan and Schneiders, \{Famke L.\}",

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doi = "10.1016/j.ctro.2025.101056",

language = "English",

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T1 - Re-irradiation of adrenal metastases using MR-guided adaptive SABR

T2 - A feasible and effective approach in a high-risk population

AU - Palacios, Miguel A.

AU - Bruynzeel, Anna M. E.

AU - van Rossum, Peter S. N.

AU - Bohoudi, Omar

AU - Senan, Suresh

AU - Schneiders, Famke L.

PY - 2026/1/1

Y1 - 2026/1/1

N2 - Re-irradiation of adrenal metastases is challenging due to cumulative dose constraints. We present seven patients treated with MR-guided adaptive stereotactic ablative radiotherapy (SABR), leveraging real-time imaging and on-table adaptation for precise dose delivery (5× 10 Gy or 3× 15 Gy). This first report of ablative-dose MR-guided SABR in re-irradiation demonstrates excellent local control and acceptable toxicity, with six patients progression-free at median 8.6 months and no grade ≥3 events (one grade 2 vertebral fracture, one grade 1 nausea). By providing a non-invasive alternative to surgery or palliative radiotherapy, MR-guided adaptive SABR expands therapeutic options for high-risk patients.

AB - Re-irradiation of adrenal metastases is challenging due to cumulative dose constraints. We present seven patients treated with MR-guided adaptive stereotactic ablative radiotherapy (SABR), leveraging real-time imaging and on-table adaptation for precise dose delivery (5× 10 Gy or 3× 15 Gy). This first report of ablative-dose MR-guided SABR in re-irradiation demonstrates excellent local control and acceptable toxicity, with six patients progression-free at median 8.6 months and no grade ≥3 events (one grade 2 vertebral fracture, one grade 1 nausea). By providing a non-invasive alternative to surgery or palliative radiotherapy, MR-guided adaptive SABR expands therapeutic options for high-risk patients.

KW - Adrenal metastasis

KW - MR linac

KW - Oligometastasis

KW - Re-irradiation

KW - SABR

UR - https://www.scopus.com/pages/publications/105018636834

U2 - 10.1016/j.ctro.2025.101056

DO - 10.1016/j.ctro.2025.101056

M3 - Article

C2 - 41141654

SN - 2405-6308

VL - 56

JO - Clinical and Translational Radiation Oncology

JF - Clinical and Translational Radiation Oncology

M1 - 101056

ER -

Re-irradiation of adrenal metastases using MR-guided adaptive SABR: A feasible and effective approach in a high-risk population

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Keywords

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