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Open adrenalectomy viable option in adrenocortical cancer
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Patients with adrenocortical carcinoma should be treated with open adrenalectomy; mitotane therapy in conjunction with radiation should be considered to delay tumor recurrence, according to recent study findings.
“Our data argues for open adrenalectomy as the initial approach to large, potentially malignant adrenal masses,” researchers wrote. “Adjuvant therapy with mitotane, especially in the combination with radiation therapy, positively affects recurrence-free survival and radiation therapy effectively decreases the risk of local tumor recurrence.”
In their retrospective study, Tobias Else, MD, of the department of internal medicine and division of metabolism, endocrinology and diabetes at the University of Michigan Hospital and Health Systems, and colleagues identified prognostic factors in 391 adult patients with the rare malignant endocrine neoplasia and sought to evaluate potential treatment options.
Their median overall survival was 35.2 months, according to data. Negative prognostic factors included cortisol production (HR=1.4, P<.001 for death, and HR=1.5, P<.001 for recurrence), tumor stage at diagnosis (stage III, HR=2.1 for both death and recurrence, P<.001; stage IV, HR=4.8 for overall survival) and tumor grade (HR=2.4 and 2, for recurrence and overall survival, respectively).
Many of the patients underwent open surgery (n=171; 71%), and 26% (n=63) underwent a laparoscopic procedure. Seven patients had a laparoscopic surgery converted to an open method, according to the study.
The open surgical method improved overall survival (HR=1.7, P<0.05), but did not affect recurrence-free survival when looking at all sites of relapse, the researchers wrote.
Mitotane therapy appeared to increase recurrence-free survival (HR=0.7, P<.05). This was significantly improved by the addition of adjuvant radiation therapy (HR=0.4, P<.05). However, it did not play a role in overall survival, researchers wrote.
“Only 9% of patients receiving adjuvant radiation therapy had local recurrence as opposed to 48% of patients without radiation therapy,” they wrote.
These data suggest the need for further studies on other adjuvant therapies for adrenocortical carcinoma, the researchers wrote.
Disclosure: One researcher reports various financial ties with Atterocor, Embera, Isis and Orphagen.
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