Skip to main content
SpringerLink
Log in

Cytotoxic treatment of adrenocortical carcinoma

  • World Progress In Surgery: Adrenal Tumors
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Adrenocortical carcinoma (ACC) is a rare, aggressive tumor that is often detected in an advanced stage. Medical treatment with the adrenotoxic drug mitotane has been used for decades, but critical prospective trials on its role in residual disease or as an adjuvant agent after surgical resection are still lacking. The concept of a critical threshold plasma level of the drug must be confirmed in controlled studies. Because individual responsiveness cannot be predicted, the use mitotane is still advised for nonresectable disease. In case of Cortisol or other steroid overproduction, several drugs (e.g., ketoconazole or aminoglutethimide) may be used. Chemotherapy with single agents (e.g., doxorubicin or cisplatin) have been disappointing, with low response rates (< 30%) and a short response duration. Part of this refractoriness may be explained by the fact that ACC tumors express the multidrug-resistance gene MDR-1. Chemotherapy with multiple agents has been tested in smaller series and has resulted in significant side effects. The best results were achieved by the combination of etoposide, doxorubicin, and cisplatin associated with mitotane, achieving a response rate of 54%, including individual complete responses. To be able to make progress in treating advanced ACC disease, adjuvant multicenter trials must be encouraged. When mitotane-based therapies are used, monitored drug levels are mandatory.

Résumé

Le cancer de la corticosurrénale (CCS) est une tumeur rare mais agressive, détectée souvent à un stade avancé. Le traitement médical par le mitotane, une drogue adrénotoxique, est utilisée depuis plusieurs décennies, mais, on manque d’essais prospectifs critiques sur son rôle dans la maladie résiduelle ou comme agent adjuvant après résection chirurgicale. Le concept d’un niveau plasmatique dont le seuil critique doit être confirmé par des études contrôlées. Puisqu’on ne peut prédire la réponse individuelle, le mitotane est toujours conseillé dans les maladies nonréséquables. En cas d’hyperproduction de Cortisol, ou d’autres Steroides, d’autres drogues, comme par exemple, le cétoconazole ou l’aminogluthétimide peuvent être utilisées. La monochimiothérapie, avec par exemple la doxorubicine et le cisplatine, est décevante avec un taux de réponse bas (<30%) et une durée de réponse courte. Une partie de cette non-réonse peut être expliquée par le fait que les CCS expriment un gène de résistance multidrogues, le MDR-1. La plurichimiothérapie a été testée dans de plus petites séries avec des effets secondaires importants. Les meilleurs résultats ont été avec la combinaison d’étoposide, de doxorubicine et de cisplatine associés au mitotane: le taux de réponse a été de 54%, avec quelques réponses individuelles complètes. Pour faire des progrès dans le CCS avancé, il faut encourager des essais multicentriques de traitement adjuvant. En cas de thérapie utilisant le mitotane, il faut obligatoirement monitorer le taux des drogues.

Resumen

El carcinoma adrenocortical (CAC) es un tumor agresivo poco frecuente que comûnmente se détecta cuando ya esta en etapas avanzadas de su desarrollo. Desde hace décadas se practica tratamiento médico con una droga adrenotöxica, el mitotane, pero no se dispone de ensayos clînicos prospectivos que soporten su valor en enfermedad residual o como adyuvante de la resection quirürgica. También se hace necesario confirmar el concepto de nivelés criticos de la droga mediante estudios controlados. Puesto que no es posible predecir la respuesta individual, todavia se aconseja el uso del mitotane en casos de enfermedad no resecable. Cuando hay superproduction de Cortisol o de otros esteroides, se pueden utilizar algunas drogas como el Ketoconazol o la aminoglutetimida. La quimioterapia con agentes ûnicos, por ejemplo doxorubicina y el cisplatino, ha sido decepcionante, por las bajas tasas (<30%) y la corta duration de la respuesta. Parte de tal situation refractaria puede explicarse por el hecho de que los CAC expresan el gen MDR-1 de resistencia multidroga. La quimioterapia con agentes multiples ha sido ensayada en series mas pequenas, con efectos secundarios significatives. Los mejores resultados se logran con la combination de etopösido, doxorubicina y cisplatino asociada con mitotane, alcanzando una tasa de respuesta del 54%, incluyendo respuestas complétas. Para lograr progreso en el manejo del CAC avanzado se debe estimular la realization de ensayos multi-institucionales. La monitoria de los nivelés de droga son obligatorios cuando se usan terapias con base en mitotane.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gröndal, S, Cedermark, B., Eriksson, B., Grimelius, L., Harach, R., Kristoffersson, A., Rastad, J., Udén, P., Åkerström, G.: Adrenocortical carcinoma: a retrospective study of a rare tumor with poor prognosis. Eur. J. Surg. Oncol. 16:500, 1990

    PubMed  Google Scholar 

  2. Khorram-Manesh, A., Ahlman, H., Jansson, S., Wängberg, B., Nilsson, O., Jakobsson, CE., Eliasson, B., Lindstedt, S., Tisell, L.E.: Adrenocortical carcinoma: surgery and mitotane for treatment and steroid profiles for follow-up. World J. Surg. 22:605, 1998

    Article  PubMed  CAS  Google Scholar 

  3. MacFarlane, D.A.: Cancer of the adrenal cortex: the natural history, prognosis and treatment in a study of fifty-five cases. Ann. R. Coll. Surg. Engl. 25:155, 1958

    Google Scholar 

  4. Sullivan, M., Bojkan, M., Hodges, C.V.: Adrenal cortical carcinoma. J. Urol. 720:660, 1978

    Google Scholar 

  5. Henley, D.J., van Heerden, J. A., Grant, CS., Carney, JA., Carpenter, P.C.: Adrenal cortical carcinoma: a continuing challenge. Surgery 94:926, 1983

    PubMed  CAS  Google Scholar 

  6. Kasperlik-Zaluska, A.A., Migdalska, B.M., Zgliczynski, S., Makowska, A.M.: Adrenocortical carcinoma: a clinical study and treatment result of 52 patients. Cancer 75:2587, 1995

    Article  PubMed  CAS  Google Scholar 

  7. Wooten, M.D., King, D.K.: Adrenal cortical carcinoma: epidemiology and treatment with mitotane and a review of the literature. Cancer 72:3145, 1993

    Article  PubMed  CAS  Google Scholar 

  8. Lipsett, M.B., Hertz, R., Ross, G.T.: Clinical and pathophysiologic aspects of adrenocortical carcinoma. Am. J. Med. 55:374, 1963

    Article  Google Scholar 

  9. Hough, A.J., Hollifield, J.W., Page, D.L., Hartmann, W.H.: Prognostic factors in adrenal cortical tumors. Am. J. Pathol. 8:163, 1984

    Article  Google Scholar 

  10. Luton, J.P., Cerdas, S., Billaud, L., Thomas, G., Guihaume, B., Bertagna, X., Laudat, M.H., Louvel, A., Chapuis, Y., Blandeau, P., Bonnin, A., Bricaire, H.: Clinical features of adrenocortical carcinoma, prognostic factors and the effect of mitotane therapv. N. Engl. J. Med. 322:1195, 1990

    PubMed  CAS  Google Scholar 

  11. Icard, P., Chapuis, Y., Andreassian, B., Bernard, A., Prove, C: Adrenocortical carcinoma in surgically treated patients: a retrospective study on 156 cases by the French Association of Endocrine Surgeons. Surgery 772:972, 1992

    Google Scholar 

  12. Cohn, K., Gottesman, L., Brennan, M.: Adrenocortical carcinoma. Surgery 100:1170, 1986

    PubMed  CAS  Google Scholar 

  13. Pommier, R.F., Brennan, M.F.: An eleven-year experience with adrenocortical carcinoma. Surgery 772:963, 1992

    Google Scholar 

  14. Lubitz, JA., Freeman, L., Okun, R: Mitotane use in inoperable adrenal cortical carcinoma. JAMA. 225:1109, 1973

    Article  Google Scholar 

  15. Schteingart, D.E., Motazedi, A., Noonan, RA., Thompson, N.W.: Treatment of adrenal carcinoma. Arch. Surg. 777:1142, 1982

    Google Scholar 

  16. Hoffmann, D.L., Mattox, V.R.: Treatment of adrenocortical carcinoma with o,p′-DDD. Med. Clin. North Am. 56:999, 1972

    Google Scholar 

  17. Decker, RA., Elson, P., Hogan, T.E., Citrin, D.L., Westring, D.W., Banerjee, T.K., Gilchrist, K.W., Horton, J., Eastern Cooperative Oncology Group,: Eastern Cooperative Oncology Group study 1879: mitotane and adriamycin in patients with advanced adrenocortical carcinoma. Surgery 110:1006, 1991

    PubMed  CAS  Google Scholar 

  18. Bukowski, R.M., Wolfe, M., Levine, H.S., Crawford, D.E., Stephens, R.L., Gaynor, E., Harker, W.G.: Phase II trial of mitotane and cisplatin in patients with adrenal carcinoma: a Southwest Oncology Group study. J. Clin. Oncol. 7:161, 1993

    Google Scholar 

  19. Fallo, F., Pilon, C., Barzon, L., Pistorello, M., Pagotto, U., Atavilla, G., Boscaro, M., Sonino, N.: Effects of taxol on the human NC1-H295 adrenocortical carcinoma cell line. Endocr. Res. 22:709, 1996

    PubMed  CAS  Google Scholar 

  20. Beruti, A., Terzolo, M., Pia, A., Angeli, A., Dogliotti, L., Italian Group for the Study of Adrenal Cancer,: Mitotane associated with etoposide, doxorubicin, and cisplatin in the treatment of advanced adrenocortical carcinoma. Cancer 55:2194, 1998

    Article  Google Scholar 

  21. Percarpio, B., Knowlton, A.H.: Radiation therapy of adrenal cortical carcinoma. Acta Radiol. Ther. Phys. Biol. 75:288, 1976

    Google Scholar 

  22. King, D.R., Lack, E.E.: Adrenal cortical carcinoma: a clinical and pathologic study of 49 cases. Cancer 44:239, 1979

    Article  PubMed  CAS  Google Scholar 

  23. Didolkar, M.S., Bescher, A., Elias, E.G., Moore, R.H.: Natural history of adrenal cortical carcinoma. Cancer 47:2153, 1981

    Article  PubMed  CAS  Google Scholar 

  24. Bergenstal, D.M., Hertz, R., Lipsett, M.B., Moy, R.H.: Chemotherapy of adrenocortical cancer with o,p′-DDD. Ann. Intern. Med. 55:672, 1960

    Google Scholar 

  25. Trainer, P.J., Besser, M.: Cushing’s syndrome: therapy directed at the adrenal glands. Endocrinol. Metab. Clin. North Am. 25:571, 1994

    Google Scholar 

  26. Hutter, A.M., Jr., Kayhoe, D.E.: Adrenal cortical carcinoma: results of treatment with o,p′ DDD in 138 patients. Am. J. Med. 47:581, 1966

    Article  Google Scholar 

  27. Boven, E., Vermorken, J.B., van Slooten, H., Pinedo, H.M.: Complete response of metastasized adrenal cortical carcinoma with o,p′-DDD: case report and literature review. Cancer 55:26, 1984

    Article  Google Scholar 

  28. Plager, J.E.: Carcinoma of the adrenal cortex: clinical description, diagnosis, and treatment. Int. Adv. Surg. Oncol. 7:329, 1984

    PubMed  CAS  Google Scholar 

  29. Venkatesh, S., Hickey, R.C., Sellin, R.V., Fernandez, J.F., Samaan, N.A.: Adrenal cortical carcinoma. Cancer 64:765, 1989

    Article  PubMed  CAS  Google Scholar 

  30. Vassilopoulou-Sellin, R., Guinée, V., Klein, M.J., Taylor, S.H., Hess, K.R., Schultz, P.N., Samaan, N.A.: Impact of adjuvant mitotane on the clinical course of patients with adrenocortical cancer. Cancer 77:3119, 1993

    Article  Google Scholar 

  31. Barzon, L., Fallo, F., Sonino, N., Daniele, O., Boscaro, M.: Adrenocortical carcinoma: experience in 45 patients. Oncology 54:490, 1997

    PubMed  CAS  Google Scholar 

  32. Barzon, L.: Is there a role for low doses of mitotane as adjuvant therapv in adrenocortical carcinoma? J. Clin. Endocrinol. Metab. 54:1488, 1999

    Article  Google Scholar 

  33. Van Slooten, H., Moolenaar, A.J., Van Seters, A.P., Smeenk, D.: The treatment of adrenocortical carcinoma with o,p′-DDD: prognostic implications of serum level monitoring. Eur. J. Cancer Clin. Oncol. 20:47, 1984

    Article  PubMed  Google Scholar 

  34. Haak, H. R., Hermans, J., Van de Velde, C.J., Lentjes, E.G., Gosling, B.M., Fleuren, G.J.: Optimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients. Br. J. Cancer 69:947, 1994

    PubMed  CAS  Google Scholar 

  35. Verhelst, J.A., Trainer, P.J., Howlett, TA., Perry, L., Rees, L.H., Grossman, A.B., Wass, J.A., Besser, G.M.: Short-and long-term responses to metyrapone in the medical management of 91 patients with Cushing’s syndrome. Clin. Endocrinol. (Oxf.) 55:169, 1991

    Article  Google Scholar 

  36. Sonino, N., Boscaro, M., Paolette, A., Mantero, F., Ziliotto, D.: Ketoconazole treatment in Cushing’s syndrome: experience in 34 patients. Clin. Endocrinol. (Oxf.) 35:347, 1991

    Article  CAS  Google Scholar 

  37. Sinnaeve, L.J.E., Becks, G.P.: Preoperative ketoconazole therapy for adrenocortical carcinoma. Can. Med. Assoc. J. 141:131, 1989

    CAS  Google Scholar 

  38. Contreras, P., Rojas, A., Biagini, L., Gonzalez, P., Massardo, T.: Regression of metastatic adrenal carcinoma during palliative ketoconazole treatment. Lancet 2:151, 1985

    Article  PubMed  CAS  Google Scholar 

  39. Bertagna, X., Basin, C., Picard, F., Varet, B., Bertagna, C., Hucher, M., Luton, P.: Peripheral antiglucocorticoid action of RU 486 in man. Clin. Endocrinol. (Oxf.) 25:537, 1988

    Article  Google Scholar 

  40. Nieman, L.K., Chrousos, G.P., Kellner, C., Spitz, I.M., Nisula, B.C., Cutter, G.B., Merriam, G.R., Bardin, C.W., Loriaux, D.L.: Successful treatment of Cushing’s syndrome with the glucocorticoid antagonist RU 486. J. Clin. Endocrinol. Metab. 67:536, 1985

    Google Scholar 

  41. Norton, J.A., Levin, B., Jensen, R.T.: Cancer of the endocrine system. In Principles and practice of Oncology (4th edition), De Vita, V.T., Jr., Hellmann, S., Rosenberg, S.A., editors, Philadelphia, Lippincott 1993, pp. 1333

    Google Scholar 

  42. Bates, S.E., Shieh, C.Y., Mickley, L.A., Dichek, H.L., Gazdar, A., Loriaux, D.L., Fojo, AT.: Mitotane enhances cytotoxicity of chemotherapy in cell lines expressing a multidrug resistance gene (mdr-l/P glycoprotein) which is also expressed by adrenocortical carcinoma. J. Clin. Endocrinol. Metab. 75:18, 1991

    Google Scholar 

  43. Flynn, S.D., Murren, J.R., Kirby, W.M., Hong, J., Kan, I., Kinder, B.K.: P-glycoprotein expression and multidrug resistance in adrenocortical carcinoma. Surgery 772:981, 1992

    Google Scholar 

  44. Andres, F., Grunenberger, F., Kurtz, J.E., Goichot, B., Dufour, P., Schlienger, J.L.: Le traitement du cortico-surrénalome malin. Presse Med. 26:880, 1997

    PubMed  CAS  Google Scholar 

  45. Teicher, B.A.: Lonidamine: in vitro/in vivo correlations. Eur. J. Cancer 30:1411, 1994

    Article  Google Scholar 

  46. Feuillau, P., Raffeld, M., Stein, CA., Lipford, N., Rehnquist, D., Meyers, CE., La Rocca, R.V., Chrousos, G.P.: Effects of suramin on the function and structure of the adrenal cortex in the cynomolgus monkey. J. Clin. Endocrinol. Metab. 65:153, 1987

    Article  Google Scholar 

  47. Allolio B., Reincke, M., Arlj, W., Deuss, U., Winkelmann, W., Siekmann, L.: Suramin for treatment of adrenal carcinoma. Lancet 7:277, 1989

    Article  Google Scholar 

  48. La Rocca, R.V., Stein, CA., Danesi, R., Tannis Dow, CA., Weiss, G.H., Meyers, CE.: Modulation of steroid hormone production, cytotoxicity in vitro and clinical antitumor effect. J. Clin. Endocrinol. Metab. 71:497, 1990

    PubMed  Google Scholar 

  49. Wu, Y.W., Chik, CL., Knazek, R.A.: An in vitro and in vivo study of antitumour effects of gossypol on human SW-13 adrenocortical carcinoma. Cancer Res. 49:3154, 1989

    Google Scholar 

  50. Flack, M.R., Pyle, R.G., Mullen, N.M., Lorenzo, B., Wu, Y.W., Knazek, R.A., Nisula, B.C., Reidenberg, M.M.: Oral gossypol in the treatment of metastatic adrenal cancer. J. Clin. Endocrinol. Metab. 76:1019, 1993

    Article  PubMed  CAS  Google Scholar 

  51. Benz, C.C., Keniry, M.A., Ford, J.M., Townsend, A.J., Cox, F.W., Palayoor, S., Matlin, S.A., Hait, W.N., Cowan, K.H.: Biochemical correlates of the antitumor and antimitochondrial properties of gossypol enantiomers. Mol. Pharmacol. 37:840, 1990

    PubMed  CAS  Google Scholar 

  52. Haq, M.M., Legha, S.S., Samaan, N.A., Bodey, G.P., Burgess, M.A.: Cytotoxic chemotherapy in adrenal cortical carcinoma. Cancer Treat. Rep. 64:909, 1980

    PubMed  CAS  Google Scholar 

  53. Chun, H.G., Yogoda, A., Kemeny, N.: Cisplatinum for adrenal cortical carcinoma. Cancer Treat. Rep. 67:513, 1983

    PubMed  CAS  Google Scholar 

  54. Hesketh, P.J., McCaffrey, R.P., Finkel, H.E., Lamon, S.S., Griffing, G.T., Melby, J.C.: Cisplatin based treatment of adrenocortical carcinoma. Cancer Treat. Rep. 77:2221, 1987

    Google Scholar 

  55. Tattersall, M.H., Lander, H., Bain, B., Stocks, A.E., Woods, R.L., Fox, R.M.: Cisplatin treatment of metastatic adrenal carcinoma. Med. J. Aust. 7:419, 1980

    Google Scholar 

  56. Van Slooten, H., Van Osterom, A.T.: CAP (cyclophosphamide, doxorubicin and cisplatin) resimen in adrenal cortical carcinoma. Cancer Treat. Rep. 67:377, 1983

    PubMed  Google Scholar 

  57. Schlumberger, M., Brugières, L., Gicquel, C., Travagli, J.P., Droz, J.P., Parmentier, C.: 5-Fluorouracil, doxorubicin and cisplatin as treatment for adrenal cortical carcinoma. Cancer 67:2997, 1991

    Article  PubMed  CAS  Google Scholar 

  58. Johnson, D.H., Greco, F.A.: Treatment of metastatic adrenal cortical carcinoma with cisplatin and etoposide (VP16). Cancer 55:2198, 1986

    Article  Google Scholar 

  59. Burgess, M.A., Legha, S.S., Sellin, R.V.: Chemotherapy with cisplatinum and etoposide (UP16) for patients with advanced adrenal cortical carcinoma (ACC). Proc. Ann. Soc. Clin. Oncol. 72:188, 1993

    Google Scholar 

  60. Zidon, J., Stipendier, M., Robinson, E.: Treatment of metastatic adrenal cortical carcinoma with etoposide (VP16) and cisplatin after failure with o.p.′DDD. Am. J. Clin. Oncol. 79:229, 1996

    Article  Google Scholar 

  61. Bonacci, R., Gigliotti, A., Baudin, E., Wion-Barbot, N., Emy, P., Bonsay, M., Cailleux, A.F., Nakib, I., Schlumberger, M., Résan Comète INSERM,: Cytotoxic therapy with etoposide and cisplatin in advanced adrenocortical carcinoma. Br. J. Cancer 75:546, 1998

    Google Scholar 

  62. Gebhardt, D.O.E., Moolenar, A.J., van Seters, A.P., van der Velde, E.A., Gevers Leuven, J.A.: The distribution of o,p′-DDD (mitotane) among serum lipoproteins in normo- and hypertriglyceridemia. Cancer Chemother. Pharmacol. 29:331, 1992

    Article  PubMed  CAS  Google Scholar 

  63. Preusser, P., Wilke, H., Achterrath, W., Fink, U., Lenaz, L., Heinicke, A., Meyer, J., Meyer, HJ., Buente, H.: Phase II study with the contribution of etoposide, doxorubicin and cisplatin in advanced measurable gastric cancer. J. Clin. Oncol. 7:1310, 1989

    PubMed  CAS  Google Scholar 

  64. Villa, R., Orlandi, L., Berrutti, A., Dogliotti, L., Zaffaroni, N.: Modulation of cytotoxic drug activity by mitotane and lonidamine in human adrenocortical carcinoma cell. Int. J. Oncol. 74:133, 1999

    Google Scholar 

  65. Carpenter, P.C.: Mitotane failure in adrenocortical cancer: where next? Cancer 77:2900, 1993

    Article  Google Scholar 

  66. Bergström, M., Bonasera, T.A., Lu, L., Bergström, E., Backlin, C., Juhlin, C., Långström, B.: In vitro and in vivo primate evaluation of carbon-11-etomidate and carbon-11-metomidate as potential tracers for PET imaging of the adrenal cortex and its tumors. J. Nucl. Med. 59:982, 1998

    Google Scholar 

  67. Gicquel, C., Raffin-Sanson, M.L., Gaston, V., Bertagna, X., Plovin, P.F., Schlumberger, M., Louvel, A., Luton, J.P., Le Bouc, Y.: Structural and functional abnormalities at lip 15 are associated with the malignant phenotype in sporadic adrenocortical tumors: study on a series of 82 tumors. J. Clin. Endocrinol. Metab. 52:2559, 1997

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Sahlgrenska University Hospital, Göteborg University, S-413 45, Göteborg, Sweden

    Håkan Ahlman M.D., Ph.D., Amir Khorram-Manesh M.D., Svante Jansson M.D., Ph.D. & Bo Wängberg M.D., Ph.D.

  2. Department of Pathology, Sahlgrenska University Hospital, Göteborg University, S-413 45, Göteborg, Sweden

    Ola Nilsson M.D., Ph.D.

  3. Department of Clinical Chemistry, Sahlgrenska University Hospital, Göteborg University, S-413 45, Göteborg, Sweden

    Carl-Erik Jacobsson M.D., Ph.D. & Sven Lindstedt M.D., Ph.D.

  4. Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, Göteborg University, S-413 45, Göteborg, Sweden

    Håkan Ahlman M.D., Ph.D., Amir Khorram-Manesh M.D., Svante Jansson M.D., Ph.D., Bo Wängberg M.D., Ph.D. & Ola Nilsson M.D., Ph.D.

Authors
  1. Håkan Ahlman M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amir Khorram-Manesh M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Svante Jansson M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bo Wängberg M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ola Nilsson M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carl-Erik Jacobsson M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sven Lindstedt M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Håkan Ahlman M.D., Ph.D..

Additional information

Published Online: June 27, 2001

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ahlman, H., Khorram-Manesh, A., Jansson, S. et al. Cytotoxic treatment of adrenocortical carcinoma. World J. Surg. 25, 927–933 (2001). https://doi.org/10.1007/s00268-001-0031-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-001-0031-6

Keywords

Search

Navigation