Adjuvant and Definitive Radiotherapy for Adrenocortical Carcinoma

• Published in: International journal of radiation oncology, biology, physics Vol. 80; no. 5; pp. 1477 - 1484
• Main Authors: Sabolch, Aaron, B.A, Feng, Mary, M.D, Griffith, Kent, M.P.H., M.S, Hammer, Gary, M.D., Ph.D, Doherty, Gerard, M.D, Ben-Josef, Edgar, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2011; Elsevier
• Subjects: Adrenal cortex; Adrenal Cortex Neoplasms - mortality; Adrenal Cortex Neoplasms - pathology; Adrenal Cortex Neoplasms - radiotherapy; Adrenal Cortex Neoplasms - therapy; ADRENAL GLANDS; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adrenocortical carcinoma; Adrenocortical Carcinoma - mortality; Adrenocortical Carcinoma - pathology; Adrenocortical Carcinoma - radiotherapy; Adrenocortical Carcinoma - secondary; Adrenocortical Carcinoma - therapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; BODY; Cancer Care Facilities; CARCINOMAS; Combined Modality Therapy - methods; DISEASES; ENDOCRINE GLANDS; Endocrinopathies; Female; GLANDS; HAZARDS; Hematology, Oncology and Palliative Medicine; Humans; Male; Malignant tumors; Medical sciences; MEDICINE; Michigan; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - prevention & control; NEOPLASMS; NUCLEAR MEDICINE; ORGANS; Proportional Hazards Models; Radiation oncology; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Radiotherapy, Adjuvant; Retrospective Studies; SURGERY; THERAPY; Treatment Outcome; Michigan; Adrenal glands; Radiotherapy; Radiation oncology; Adrenocortical carcinoma; Adrenal cortex; Endocrinopathy; Adrenal cortex carcinoma; Adrenal gland diseases; Adjuvant treatment; Malignant tumor; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.04.030

Purpose To evaluate the impact of both adjuvant and definitive radiotherapy on local control of adrenocortical carcinoma. Methods and Materials Outcomes were analyzed from 58 patients with 64 instances of treatment for adrenocortical carcinoma at the University of Michigan's Multidisciplinary Adrenal Cancer Clinic. Thirty-seven of these instances were for primary disease, whereas the remaining 27 were for recurrent disease. Thirty-eight of the treatment regimens involved surgery alone, 10 surgery plus adjuvant radiotherapy, and 16 definitive radiotherapy for unresectable disease. The effects of patient, tumor, and treatment factors were modeled simultaneously using multiple variable Cox proportional hazards regression for associations with local recurrence, distant recurrence, and overall survival. Results Local failure occurred in 16 of the 38 instances that involved surgery alone, in 2 of the 10 that consisted of surgery plus adjuvant radiotherapy, and in 1 instance of definitive radiotherapy. Lack of radiotherapy use was associated with 4.7 times the risk of local failure compared with treatment regimens that involved radiotherapy (95% confidence interval, 1.2–19.0; p = 0.030). Conclusions Radiotherapy seems to significantly lower the risk of local recurrence/progression in patients with adrenocortical carcinoma. Adjuvant radiotherapy should be strongly considered after surgical resection.