Hyperthermic Intraperitoneal Chemotherapy for Primary or Recurrent Adrenocortical Carcinoma. A Single Center Study

Abstract

Background. This study explores the impact of Hypertermic Intra PEritoneal Chemotherapy (HIPEC) on adrenocortical carcinoma (ACC) management through a safety analysis completed by a preliminary evaluation of survival performances. Methods. Retrospective chart review of 27 patients submitted to surgical treatment completed by HIPEC for primary (SP, 13 patients) or recurrent (SR, 14 patients, 17 treatments) ACC. Safety was evaluated by means of procedural morbidity and mortality. Survival performances included multiple end points: local/peritoneal disease-free survival (l/pDFS), overall progression-free survival (OPFS), and overall survival (OS). Results. In the SP group, mortality was nil and morbidity was 46% (major 23%). At a median follow-up of 25 months, the median value for all the different survival measures had not been reached. Mortality was also nil in the SR group. However, morbidity was 77% (major 18%). Median l/pDFS and OPFS were 12 ± 4 and 8 ± 2 months, respectively. At a median follow-up of 30 months, median OS had not been reached. Conclusion. Surgery and HIPEC is an invasive procedure. Its employment in the surgery for primary setting deserves attention as it may affect oncologic outcomes positively. Its value in the management of recurrences seems less appreciable, albeit it may find its place in the multimodal management of a rare disease for which multiple therapeutic options do not yet exist.

Bridging the Scientific Gaps to Identify Effective Treatments in Adrenocortical Cancer

“…When HIPEC was used prophylactically at the initial operation for the primary tumor, there was peritoneal recurrence in 1 of 13 patients at a median follow-up of 25 months. Peritoneal recurrence was 68% for recurrent disease at a median follow-up of 30 months [ 56 ]. This is similar to the National Institutes of Health (NIH) experience treating recurrent ACC with HIPEC, where recurrence was 70% at a median follow-up of 23 months and 2/9 patients died from disease progression.…”

“…This is similar to the National Institutes of Health (NIH) experience treating recurrent ACC with HIPEC, where recurrence was 70% at a median follow-up of 23 months and 2/9 patients died from disease progression. As with HIPEC in general, there was high morbidity in both studies, ranging from 40–70% [ 56 , 57 ]. More data are needed to make firm conclusions about the use of HIPEC in the prophylactic setting, but the limited data available have shown it is ineffective for recurrent disease.…”

Adrenocortical Carcinoma

“…One paper presents the results of a single institution experience regarding the potential efficacy of hypertermic intra-peritoneal chemotherapy (HIPEC) after radical surgery. The results show that this therapeutic procedure might result in long-term disease control, particularly in treatment-naïve patients [ 24 ].…”

Recurrence-Free Survival Following Aggressive Multimodal Treatment of an Isolated Recurrence of Adrenocortical Carcinoma

“…A recent study demonstrates that hyperthermic intraperitoneal chemotherapy immediately following primary resection has been shown to improve local recurrence, though is limited by significant morbidity and requires careful candidate selection. Furthermore, it has not yet demonstrated clear benefit in treating recurrent disease [9]. In patients with unresectable locally advanced or metastatic disease, Laganà et al (2020) have shown some long-term benefit in EDP-M chemotherapy (etoposide, doxorubicin and cisplatin plus oral mitotane), including the eventual possibility of surgically excising residual disease following treatment response [10]; however, this similarly comes at the cost of systemic chemotherapy with significant toxicity.…”