Adrenocortical carcinoma: is adjuvant therapy indicated? A single institution experience

Abstract

Background. Adrenocortical carcinomas are rare tumors with an aggressive natural history. Complete surgical resection of the tumor is possible only in few patients, and even after complete resection many patients develop local recurrence of tumor or distant metastases. The role of adjuvant chemotherapy is not established, and there are no published series on the probable benefit of adjuvant cisplatin-based chemotherapy.

Methods. In this retrospective study, 17 patients with completely excised adrenocortical carcinoma were given adjuvant treatment (n = 7) or placed on observation (n = 10). Adjuvant treatment included chemotherapy, using a combination of cisplatin and etoposide, and/or tumor bed irradiation.

Results. All 4 patients who received adjuvant chemotherapy are alive and disease-free at a median follow-up period of 28 months. None of the 3 patients who received local radiotherapy showed evidence of local recurrence. Seven of the 10 patients placed on observation alone had disease recurrence at local (n = 2), distant (n = 1), or both local and distant sites (n = 4).

Conclusion. Adjuvant chemotherapy or radiotherapy appeared to delay both local and distant relapses in completely resected adrenocortical carcinoma in this small retrospective series. Initial results of adjuvant therapy with cisplatin and etoposide in adrenocortical carcinoma are promising and warrant further studies.