Supplementary Material for: MRI-Guided Adaptive Radiation Therapy for Oligometastatic Prostate Cancer Involving the Adrenal Gland: A Case Report and Literature Review

Metastasis-directed therapy is an evolving treatment modality for patients with oligometastatic prostate cancer. Although the microenvironment of the adrenal glands is enriched in androgen precursors, isolated adrenal metastases are rare. The application of stereotactic ablative radiotherapy to oligometastatic adrenal lesions has been limited due to toxicity concerns. Here, we report a patient with castration resistant prostate cancer and oligometastatic disease recurrence to the adrenal gland who underwent MRI-guided adaptive radiotherapy which allowed accurate delivery of stereotactic ablative radiotherapy (SBRT) while minimizing exposure to adjacent radio-sensitive organs. This approach was safe and resulted in long-term local and systemic disease control. In conclusion, this case highlights the potential role for MRI-guided SBRT in selected patients with oligometastatic prostate cancer to the adrenal glands.