When I first posted on this forum, I asked if anyone was in my husband's situation: no primary tumor but two isolated mets, one in the 4th lumbar vertebrae, the other in the left adrenal gland. Now that I've been here a while, I know that this is a pretty unusual situation! Yet isolated mets from CRC to the adrenal gland do occur - just not as often as, say, liver or lung mets: "Metastasis to the adrenal gland is a relatively frequent autopsy finding in cancer patients. Adrenal metastasis from colorectal cancer (CRC) is not rare; however, it usually occurs in patients with multiple synchronous metastases in the terminal stage of cancer. Solitary and clinically curable adrenal metastasis from CRC is extremely unusual."
When we met with the urologist who's going to perform my husband's adrenalectomy next week, he told us that 20 years ago, nobody would have considered treatment beside systemic chemo. Then 10 years ago, it would have been a major, let's-cut-you-all-open surgery. Now it is routinely done laparoscopically - an overnight at the hospital and you go home, able to resume activities fully within the week! Several studies have now shown the benefits (in terms of survival) of directly tackling the tumor, either using radiation (SBRT) or via surgery. At first we thought my husband would be treated via radiation, but his guts make a loop very close to the tumor site and there was concern of "friendly fire". That's fine with us, we'd rather they take the damn thing out! Expecially since it's on the left side, which is easier to access.
Here are links to publications I found:
Cancer, Adrenal Metastasis
https://www.ncbi.nlm.nih.gov/books/NBK441879/Surgery:
The role of laparoscopic resection of metastases to adrenal glands
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566667/Laparoscopic Adrenalectomy for Isolated Adrenal Metastasis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016821/Adrenalectomy may increase survival of patients with adrenal metastases
https://bmcsurg.biomedcentral.com/artic ... 015-0088-zEndoscopic Retroperitoneal Adrenalectomy for Adrenal Metastases
https://www.hindawi.com/journals/ije/2014/806194/Long-term survival after adrenal metastasectomy from colorectal cancer: a report of two cases
https://surgicalcasereports.springerope ... 019-0611-zSBRT
SBRT to adrenal metastases provides high local control with minimal toxicity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707423/Stereotactic body radiation therapy for adrenal gland metastases: Outcomes and toxicity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200881/SBRT: A viable option for treating adrenal gland metastases
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661344/
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary
Tumors: L4 04/18; left adrenal gland & small lung nodules 03/19
rectum 02/22 (pT3 pN0 stage 2A); L3 09/22
Surgeries: intestinal resect. 05/18 (no cancer - Crohn's); adrenalectomy 02/20
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22
L2-L3 fusion and corpectomy 09/22
Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22; Xeloda/Avastin since 01/24