Radiation Therapy for Adrenocortical Carcinoma

  • Aaron Sabolch
  • Edgar Ben-JosefEmail author


Radiotherapy has been historically considered ineffective in the management of ACC, despite the fact that the modality provides good palliation in unresectable tumors. Further, new research has shown that radiotherapy may also be effective in an adjuvant setting, though it remains underutilized in this regard.


Adjuvant Radiotherapy Adrenocortical Carcinoma National Cancer Data Base Resection Margin Status Omental Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Grateful acknowledgement is made to Karen Vineberg and Steven Kronenberg for their exceptional assistance with all figures.


  1. 1.
    Percarpio B, Knowlton AH (1976) Radiation therapy of adrenal cortical carcinoma. Acta Radiol Ther Phys Biol 15:288–292PubMedGoogle Scholar
  2. 2.
    Bradley III EL (1975) Primary and adjunctive therapy in carcinoma of the adrenal cortex. Surg Gynecol Obstet 141:507–511Google Scholar
  3. 3.
    Cohn K et al (1986) Adrenocortical carcinoma. Surgery 100:1170–1177PubMedGoogle Scholar
  4. 4.
    Didolkar MS et al (1981) Natural history of adrenal cortical carcinoma: a clinicopathologic study of 42 patients. Cancer 47:2153–2161CrossRefPubMedGoogle Scholar
  5. 5.
    King DR, Lack EE (1979) Adrenal cortical carcinoma: a clinical and pathologic study of 49 cases. Cancer 44:239–244CrossRefPubMedGoogle Scholar
  6. 6.
    Magee BJ et al (1987) Adrenal cortical carcinoma: survival after radiotherapy. Clin Radiol 38:587–588CrossRefPubMedGoogle Scholar
  7. 7.
    Markoe AM et al (1991) Radiation therapy for adjunctive treatment of adrenal cortical carcinoma. Am J Clin Oncol 14:170–174CrossRefPubMedGoogle Scholar
  8. 8.
    Nader S et al (1983) Adrenal cortical carcinoma: a study of 77 cases. Cancer 52:707–711CrossRefPubMedGoogle Scholar
  9. 9.
    Vassilopoulou-Sellin R et al (1993) Impact of adjuvant mitotane on the clinical course of patients with adrenocortical cancer. Cancer 71:3119–3123CrossRefPubMedGoogle Scholar
  10. 10.
    Polat B et al (2009) Radiotherapy in adrenocortical carcinoma. Cancer 115:2816–2823CrossRefPubMedGoogle Scholar
  11. 11.
    Kebebew E et al (2006) Extent of disease at presentation and outcome for adrenocortical caricnoma: have we made progress? World J Surg 30:872–878CrossRefPubMedGoogle Scholar
  12. 12.
    Macfarlane DA (1958) Cancer of the adrenal cortex: the natural hisotry, prognosis, and treatment in a study of 55 cases. Ann R Coll Surg Engl 23:155–186PubMedGoogle Scholar
  13. 13.
    Sullivan M et al (1978) Adrenal cortical carcinoma. J Urol 120:660–665PubMedGoogle Scholar
  14. 14.
    DeLellis RA et al (eds) (2004) Pathology and genetics of tumours of endocrine organs. International Agency for Research on Cancer, LyonGoogle Scholar
  15. 15.
    Icard P et al (2001) Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons Study Group. World J Surg 25:891–897CrossRefPubMedGoogle Scholar
  16. 16.
    Fassnacht M et al (2009) Limited prognostic value of the 2004 International union against cancer staging classification for adrenocortical carcinoma: proposal for a revised TNM classification. Cancer 115:243–250CrossRefPubMedGoogle Scholar
  17. 17.
    Abiven G et al (2006) Clinical and biological features in the prognosis of adrenocortical cancer: poor outcome of cortisol-secreting tumors in a series of 202 consecutive patients. J Clin Endocrinol Metab 91:2650–2655CrossRefPubMedGoogle Scholar
  18. 18.
    Bellantone Rl et al (1997) Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma. Surgery 122:1212–1218CrossRefPubMedGoogle Scholar
  19. 19.
    Gonzalez RJ et al (2007) Response to mitotane predicts outcome in patients with recurrent adrenal cortical carcinoma. Surgery 142:869–875CrossRefGoogle Scholar
  20. 20.
    Paton BL et al (2006) Outcomes of adrenal cortical carcinoma in the United States. Surgery 140:914–920CrossRefPubMedGoogle Scholar
  21. 21.
    Schulick RD, Brennan MF (1999) Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol 6:719–726CrossRefPubMedGoogle Scholar
  22. 22.
    Billimoria KY et al (2008) Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer 113:3130–3136CrossRefGoogle Scholar
  23. 23.
    Soreide JA et al (1992) Adrenal cortical carcinoma in Norway, 1970–1984. World J Surg 16:663–668CrossRefPubMedGoogle Scholar
  24. 24.
    Bodie B et al (1989) The Cleveland clinic experience with adrenal cortical carcinoma. J Urol 141:257–260PubMedGoogle Scholar
  25. 25.
    Henley DJ et al (1983) Adrenal cortical carcinoma: a continuing challenge. Surgery 94:926–931PubMedGoogle Scholar
  26. 26.
    Pommier RF, Brennan MF (1992) An eleven-year experience with adrenocortical carcinoma. Surgery 112:963–971PubMedGoogle Scholar
  27. 27.
    Zografos GC et al (1994) Adrenal adenocarcinoma: a review of 53 cases. J Surg Oncol 55:160–164CrossRefPubMedGoogle Scholar
  28. 28.
    Luton JP et al (1990) Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med 322:1195–1201CrossRefPubMedGoogle Scholar
  29. 29.
    Fassnacht M et al (2006) Efficacy of adjuvant radiotherapy of the tumor bed on local recurrence of adrenocortical carcinoma. J Clin Endocrinol Metab 91:4501–4504CrossRefPubMedGoogle Scholar
  30. 30.
    Kirschner LS (2006) Editorial: paradigms for adrenal cancer: think globally, act locally. J Clin Endocrinol Metab 91:4250–4252CrossRefPubMedGoogle Scholar
  31. 31.
    Haak HR et al (1994) Optimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients. Br J Cancer 69:947–951PubMedGoogle Scholar
  32. 32.
    Icard P et al (1992) Adrenocortical carcinoma in surgically treated patients: a retrospective study on 156 cases by the French Association of Endocrine Surgery. Surgery 112:972–980PubMedGoogle Scholar
  33. 33.
    Kendrick ML et al (2001) Adrenocortical carcinoma: surgical progress or status quo? Arch Surg 136:543–549CrossRefPubMedGoogle Scholar
  34. 34.
    Venkatesh S et al (1989) Adrenal cortical carcinoma. Cancer 64:765–769CrossRefPubMedGoogle Scholar
  35. 35.
    Terzolo M et al (2007) Adjuvant mitotane treatment for adrenocortical carcinoma. N Engl J Med 356:2372–2380CrossRefPubMedGoogle Scholar
  36. 36.
    Hutter Jr AM, Kayhoe DE (1966) Adrenal cortical carcinoma: clinical features of 138 patients. Am J Med 41:572–580CrossRefPubMedGoogle Scholar
  37. 37.
    Hogan TF et al (1980) A clinical and pathological study of adrenocortical carcinoma. Cancer 45:2880–2883CrossRefPubMedGoogle Scholar
  38. 38.
    Volante M et al (2008) Pathological and molecular features of adrenocortical carcinoma: an update. J Clin Pathol 61:787–793CrossRefPubMedGoogle Scholar
  39. 39.
    Berruti A et al (2008) Emerging drugs for adrenocortical carcinoma. Expert Opin Emerg Drugs 13:497–509CrossRefPubMedGoogle Scholar
  40. 40.
    Harrison LE et al (1999) Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection. Arch Surg 134:181–185CrossRefPubMedGoogle Scholar
  41. 41.
    Weis LM (1984) Comparitive histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors. Am J Surg Pathol 8:163–169CrossRefGoogle Scholar
  42. 42.
    Weiss LM et al (1989) Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol 13:202–206CrossRefPubMedGoogle Scholar
  43. 43.
    Barzon L et al (1999) Is there a role for low doses of mitotane (o,p’-DDD) as adjuvant therapy in adrenocortical carcinoma? J Clin Endocrinol Metab 84:1488–1489CrossRefPubMedGoogle Scholar
  44. 44.
    Skogseid B et al (2008) First International Randomized trial in locally advanced and Metastatic Adrenocortical Carcinoma Treatment. Accessed 11 Dec 2008
  45. 45.
    Hajjar RA et al (1975) Adrenal cortical carcinoma: a study of 32 patients. Cancer 35:549–554CrossRefPubMedGoogle Scholar
  46. 46.
    Huvos AG et al (1970) Adrenal cortical carcinoma: clinicopathologic study of 34 cases. Cancer 25:354–361CrossRefPubMedGoogle Scholar
  47. 47.
    Murphy WT (1967) Radiation therapy. WB Saunders, Philadelphia, PAGoogle Scholar
  48. 48.
    Kasperlik-Zaluska AA et al (1995) Adrenocortical carcinoma: a clinical study and treatment results of 52 patients. Cancer 75:2587–2591CrossRefPubMedGoogle Scholar
  49. 49.
    Sathya J et al (2005) Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 23:1192–1199CrossRefPubMedGoogle Scholar
  50. 50.
    Zietman A et al (2005) Comparison of Conventional-Dose vs High-Dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate a randomized controlled trial. JAMA 294:1233–1239CrossRefPubMedGoogle Scholar
  51. 51.
    Kuban D et al (2008) Long-term results of the MD Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 70:67–74CrossRefPubMedGoogle Scholar
  52. 52.
    Viani G et al (2009) Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys 74:1405–1418CrossRefPubMedGoogle Scholar
  53. 53.
    Overgaard M et al (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353:1641–1648CrossRefPubMedGoogle Scholar
  54. 54.
    Ragaz J et al (1997) Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337:956–962CrossRefPubMedGoogle Scholar
  55. 55.
    Commission on Cancer (2008) The American College of Surgeons Commission on cancer: national cancer data base. Accessed 9 Dec 2008
  56. 56.
    Surveillance Research Program of the National Cancer Institute (2008) Surveillance, epidemiology, and end results web site. Accessed 9 Dec 2008
  57. 57.
    Schteingart DE et al (2005) Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer 12:667–680CrossRefPubMedGoogle Scholar
  58. 58.
    Stewart DR et al (1974) Carcinoma of the adrenal gland in children. J Pediatr Surg 9:59–67CrossRefPubMedGoogle Scholar
  59. 59.
    Cerquetti L et al (2008) Mitotane increases the radiotherapy inhibitory effect and induces G2-arrest in combined treatment on both H295r and SW13 adrenocortical cell lines. Endocr Relat Cancer 15:623–634CrossRefPubMedGoogle Scholar
  60. 60.
    Li F et al (1988) A cancer family syndrome in twenty-four kindreds. Cancer Res 48:5358–5362PubMedGoogle Scholar
  61. 61.
    Henry I et al (1989) Molecular definition of the 11p15. 5 region involved in Beckwith-Wiedemann syndrome and probably in predisposition to adrenocortical carcinoma. Hum Genet 81:273–277CrossRefPubMedGoogle Scholar
  62. 62.
    Skogseid B et al (1992) Clinical and genetic features of adrenocortical lesions in multiple endocrine neoplasia type 1. J Clin Endocrinol Metab 75:76–81CrossRefPubMedGoogle Scholar
  63. 63.
    Painter T, Jagelman D (1985) Adrenal adenomas and adrenal carcinomas in association with hereditary adenomatosis of the colon and rectum. Cancer 55:2001–2004CrossRefPubMedGoogle Scholar
  64. 64.
    Li F, Fraumeni J (1969) Soft-tissue sarcomas, breast cancer, and other neoplasms: a familial syndrome? Ann Intern Med 71:747–752PubMedGoogle Scholar
  65. 65.
    Li F, Fraumeni J (1982) Prospective study of a family cancer syndrome. JAMA 247:2692–2694CrossRefPubMedGoogle Scholar
  66. 66.
    Hartley A et al (1989) Are germ cell tumors part of the Li-Fraumeni cancer family syndrome? Cancer Genet Cytogenet 42:221–226CrossRefPubMedGoogle Scholar
  67. 67.
    Malkin D et al (1990) Germ line p53 mutations in a familial syndrome of breast cancer, sarcomas, and other neoplasms. Science 250:1233–1238CrossRefPubMedGoogle Scholar
  68. 68.
    Hisada M et al (1998) Multiple primary cancers in families with Li-Fraumeni syndrome. J Nat Cancer Inst 90:606–611CrossRefPubMedGoogle Scholar
  69. 69.
    Varley J et al (1999) Are there low-penetrance TP53 alleles? evidence from childhood adrenocortical tumors. Am J Hum Genet 65:995–1006CrossRefPubMedGoogle Scholar
  70. 70.
    Limacher J et al (2001) Two metachronous tumors in the radiotherapy fields of a patient with Li-Fraumeni syndrome. Int J Cancer 96:238–242CrossRefPubMedGoogle Scholar
  71. 71.
    Birch J et al (2001) Relative frequency and morphology of cancers in carriers of germline TP 53 mutations. Oncogene 20:4621–4628CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Radiation OncologyUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Department of Radiation OncologyUniversity of Michigan Health System, University of MichiganAnn ArborUSA

Personalised recommendations