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J Thorac Oncol. 2014 Apr;9(4):442-6. doi: 10.1097/JTO.0000000000000133.

Adrenal metastases in lung cancer: clinical implications of a mathematical model.

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*Division of Hematology Oncology, Department of Medicine, Moore's Cancer Center, University of California San Diego, San Diego, California; †Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California; ‡Department of Mathematics, University of Southern California, Los Angeles, California; §Department of Pathology, Scripps Clinic, La Jolla, California; ‖Division of Oncology and Hematology, Billings Clinic, Billings, Montana; and ¶Department of Cell Biology, The Scripps Research Institute, La Jolla, California.


Adrenal gland metastases are common in lung cancer. It is well recognized that aggressive treatment of solitary adrenal metastases leads to improved outcomes but the exact nature of adrenal deposits is not well understood. Controversy exists as to the routing of cancer cells to the adrenal gland with some believing that this transmission is lymphatic, in contrast to the more generally accepted theory of hematogenous spread. Recently published mathematical modeling of cancer progression strongly supports the lymphatic theory. With that in mind, we performed a literature review to look for biological plausibility of simulation results and believe that evidence supports the contention that metastases to the adrenal gland can be routed by means of lymphatic channels. This could explain improved survival for patients in whom solitary adrenal metastases are managed aggressively with surgical or radiation modalities. We are calling for clinical trials prospectively testing this hypothesis.

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