Adjuvant Radiation Improves Recurrence-Free Survival and Overall Survival in Adrenocortical Carcinoma

Abstract

Context Adrenocortical carcinoma (ACC) is a rare malignancy with high rates of recurrence and poor prognosis. The role of radiotherapy (RT) in localized ACC has been controversial, and RT is not routinely offered. Objective To evaluate the benefit of adjuvant RT on outcomes in ACC. Design This is a retrospective propensity-matched analysis. Setting All patients were seen through the University of Michigan’s Endocrine Oncology program, and all those who underwent RT were treated at the University of Michigan. Participants Of 424 patients with ACC, 78 were selected; 39 patients underwent adjuvant radiation. Intervention Adjuvant RT to the tumor bed and adjacent lymph nodes. Main Outcomes Measures Time to local failure, distant failure, or death. Results Median follow-up time was 4.21 years (95% CI, 2.79 to 4.94). The median radiation dose was 55 Gy (range, 45 to 60). The 3-year overall survival estimate for patients improved from 48.6% for patients without RT (95% CI, 29.7 to 65.2) to 77.7% (95% CI, 56.3 to 89.5) with RT, with a hazard ratio (HR) of 3.59 (95% CI, 1.60 to 8.09; P = 0.002). RT improved local recurrence-free survival (RFS) from 34.2% (95% CI, 18.8 to 50.3) to 59.5% (95% CI, 39.0 to 75.0), with an HR of 2.67 (95% CI, 1.38 to 5.19; P = 0.0035). RT improved all RFS from 18.3% (95% CI, 6.7 to 34.3) to 46.7% (95% CI, 26.9 to 64.3), with an HR 2.59 (95% CI, 1.40 to 4.79; P = 0.0024). Conclusions In the largest single institution study to date, adjuvant RT after gross resection of ACC improved local RFS, all RFS, and overall survival in this propensity-matched analysis. Adjuvant RT should be considered a part of multidisciplinary management for patients with ACC.

Adjuvant Therapy in Adrenocortical Carcinoma: Reflections and Future Directions

“…In a meta-analysis, adjuvant radiotherapy had a significant benefit on local recurrence (RR, 0.24; 95% CI, 0.12-0.49), but no effect on disease survival and OS [67]. Most recently, a single-institution, propensity-matched retrospective analysis evaluated adjuvant XRT and found that using adjuvant XRT was associated with improved local RFS, all RFS, and OS [68]. So far, there is no prospective data to ascertain the value of adjuvant radiotherapy and findings of retrospective data need to be carefully interpreted because of the potential of referral and selection biases.…”

mTOR-Mediated Antioxidant Activation in Solid Tumor Radioresistance

“…us, controlling the signals associated with radiation-induced resistant genes might be a major strategy in radiotherapy to reduce the irradiation burden in the host [10,11]. For this reason, the discovery of adjuvants targeting radioresistant molecules is important for effective radiotherapy [12,13].…”

Outcome of multidisciplinary management of adrenocortical carcinoma: a retrospective study

“…The local recurrence rate of adjuvant RT group was signi cantly reduced to 5% vs. 60% of non-RT group, although there was no difference in OS. The largest study [30] on this subject included 39 patients with a median irradiation does of 55Gy, and found that adjuvant RT signi cantly improved the local recurrence (33.3% vs. 71.8%) and OS (77.7% vs. 48.6% at 3 years). In the present study, only 16.7% patients in adjuvant RT group experienced local recurrences, which was signi cantly lower than 51.7% in non-RT group.…”