Mills MN, et al. - Researchers report outcomes of patients with malignant adrenal lesions treated with stereotactic body radiotherapy (SBRT) at a single institution. They also assessed the prognostic significance of systemic inflammation biomarkers. There were 27 cases with malignant adrenal lesions managed with 31 SBRT treatments from November 2007 to February 2018. The patients were observed for a median duration of 8 months. The complete response and partial response rates were estimated to be 59% and 9%, respectively. The stable disease and progressive disease rates were 32% and 0%, respectively. The 1-year local control (LC), overall survival (OS), and freedom from progression were estimated to be 77.7%, 38.0%, and 10.0%, respectively. In multivariate analysis, a trend toward significance was revealed for pretreatment neutrophil to lymphocyte ratio > 4.1 predicting inferior OS. In this study, adequate LC for adrenal lesions was achieved with SBRT with minimal toxicity—a finding that supports the limited existing literature. In these patients, pretreatment neutrophil to lymphocyte ratio may be used as a prognostic factor.