Recurrent or metastatic disease in select patients with adrenocortical carcinoma. Aggressive resection vs chemotherapy
J. C. Jensen, H. I. Pass, W. F. Sindelar and J. A. Norton
Surgical Metabolism Section, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892.
In a retrospective, nonrandomized comparison of patients with first
recurrence of adrenocortical cancer, 18 patients were treated with
chemotherapy (primarily mitotane) and 15 patients were treated with
surgical resection plus similar chemotherapy. Surgical resection of
recurrent adrenocortical cancer was often extensive, with morbidity in 20%
of patients and no mortality. Mitotane therapy was ineffective at
controlling tumor growth. Median survival from the time of diagnosis for
all patients was only 23 months and no patient was cured. Disease-free
interval greater than 12 months was associated with prolonged survival, but
it only occurred in six patients (18%), with a similar frequency in both
treatment groups. Surgical resection of recurrent disease was associated
with prolonged survival from the time of first recurrence. The potential
benefit of this resection was evident in the 5 patients (33%) who were able
to live greater than 5 years from the time of first recurrence with
improvement in symptoms and signs of hypercortisolism. Although no patient
with recurrent adrenal cancer could be cured, resection of recurrent
disease was associated with a slight prolongation of survival and good
palliation of Cushing's syndrome.
