Surgery for recurrent adrenocortical carcinoma: A multicenter retrospective study

Simon, G.; Pattou, François; Mirallié, Éric; Lifante, Jean Christophe; Nominé, Claire; Arnault, Vincent; Calan, Loïc de; Caillard, C.; Carnaille, B.; Brunaud, Laurent; Laplace, Nathalie; Caïazzo, Robert; Blanchard, Claire

doi:10.1016/j.surg.2016.08.058

Cited by 27 publications

(28 citation statements)

References 24 publications

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“…Adverse effects from chemotherapy, however, are common and diverse (see Appendix 6). Sixteen studies focused on surgery in recurrent and advanced ACC; six publications reported on oligometastasectomy (lung and liver) (126,127,128,129,130,131), whereas ten publications assessed the effect of surgery in local recurrent and/or metastatic disease (61,66,78,132,133,134,135,136,137,138). In patients with metastasectomy, 5-year survival rates up to 40% were reported (126,127), although control groups were lacking (+OOO).…”

Section: Question 4: Therapy For Advanced or Recurrent Diseasementioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Dekkers

Else

et al. 2018

European Journal of Endocrinology

610

867

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Adrenocortical carcinoma (ACC) is a rare and in most cases steroid hormone-producing tumor with variable prognosis. The purpose of these guidelines is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with ACC based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions, which we judged as particularly important for the management of ACC patients and performed systematic literature searches: (A) What is needed to diagnose an ACC by histopathology? (B) Which are the best prognostic markers in ACC? (C) Is adjuvant therapy able to prevent recurrent disease or reduce mortality after radical resection? (D) What is the best treatment option for macroscopically incompletely resected, recurrent or metastatic disease? Other relevant questions were discussed within the group. Selected Recommendations: (i) We recommend that all patients with suspected and proven ACC are discussed in a multidisciplinary expert team meeting. (ii) We recommend that every patient with (suspected) ACC should undergo careful clinical assessment, detailed endocrine work-up to identify autonomous hormone excess and adrenal-focused imaging. (iii) We recommend that adrenal surgery for (suspected) ACC should be performed only by surgeons experienced in adrenal and oncological surgery aiming at a complete en bloc resection (including resection of oligo-metastatic disease). (iv) We suggest that all suspected ACC should be reviewed by an expert adrenal pathologist using the Weiss score and providing Ki67 index. (v) We suggest adjuvant mitotane treatment in patients after radical surgery that have a perceived high risk of recurrence (ENSAT stage III, or R1 resection, or Ki67 >10%). (vi) For advanced ACC not amenable to complete surgical resection, local therapeutic measures (e.g. radiation therapy, radiofrequency ablation, chemoembolization) are of particular value. However, we suggest against the routine use of adrenal surgery in case of widespread metastatic disease. In these patients, we recommend either mitotane monotherapy or mitotane, etoposide, doxorubicin and cisplatin depending on prognostic parameters. In selected patients with a good response, surgery may be subsequently considered. (vii) In patients with recurrent disease and a disease-free interval of at least 12 months, in whom a complete resection/ablation seems feasible, we recommend surgery or alternatively other local therapies. Furthermore, we offer detailed recommendations about the management of mitotane treatment and other supportive therapies. Finally, we suggest directions for future research.

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Section: Question 4: Therapy For Advanced or Recurrent Diseasementioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Dekkers

Else

et al. 2018

European Journal of Endocrinology

610

867

View full text Add to dashboard Cite

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“…Our approach to advanced disease was aggressive: complete en bloc surgical resection where feasible which is supported by the international literature . There is evidence that complete resection of primary adrenal disease confers survival benefits even in the presence of metastatic disease . In our secondary cohort, two patients were referred with incompletely resected disease at index operation, both undertaken laparoscopically.…”

Section: Discussionmentioning

confidence: 82%

Treatment and management of adrenal cancer in a specialized Australian endocrine surgical unit: approaches, outcomes and lessons learnt

Kwok

Zhao

Glover

et al. 2019

ANZ Journal of Surgery

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Background: Adrenocortical carcinoma is a rare and heterogeneous malignancy with poor outcomes. Recent research has suggested that outcomes may be improved by centralization of care in specialist centres. We review our evolving 21-year experience in managing adrenocortical carcinoma with a view towards outcomes and lessons learnt. Methods: A retrospective study of patients treated in our specialist endocrine surgical unit over 21 years was undertaken. Results: Thirty-five patients were treated from diagnosis, 29 forming a primary study cohort. Additionally, seven patients were referred to us for quaternary care, forming a secondary study cohort. The European Network for the Study of Adrenal Tumours (ENSAT) stage and immunohistochemical marker Ki-67 index were strong prognostic indicators for survival. Conclusions: Early stage, complete resection and Ki-67 <10% are the best prognosticators for survival. Aggressive surgical resection at index operation and of recurrent oligometastatic disease along with multimodal adjuvant treatment has led to long-term survivors of patients with Stage 4 disease in our aggregate cohort.

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“…Reoperation can signi cantly improve the prognosis when the recurrence can be completely removed, especially in patients with a disease-free survival (DFI) >12 months. Simon et al included 59 patients who recurred after initial operative resection, and the OS of 29 reoperated patients was signi cantly better than that of the 30 non-operated patients (91m vs. 15m, p <0.001) [5]. Baur et al reported 43 patients who underwent liver metastases resection with a 5-year survival rate of 51.3% and a median OS of 76.1 months [12].…”

Section: Discussionmentioning

confidence: 99%

“…Women develop ACCs more often than men with female/male ratio 1.5 to 2.5 :1 [2,3]. In spite of low annual incidence of 1-2 case per million population [4], most tumors are diagnosed at an advanced stage with invasion of adjacent organs or metastatic disease [5]. Based on the tumor staging classi cation suggested by the European Network for Study of Adrenal Tumors (ENSAT), the estimated 5-year overall survival of stage I, II, III and IV are 82%, 61%, 50% and 13%, respectively [6].…”

Section: Introductionmentioning

confidence: 99%

“…As for isolated recurrent ACC, if complete resection is possible, aggressive surgical resection seems to be the best method to prolong survival. Some studies have proved that the median survival after recurrence could be more than 60 months in patients receiving reoperation [5]. For patients with resectable liver metastases, surgical resection should be considered with a 5-year overall survival of 39% [12].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of multidisciplinary management of adrenocortical carcinoma: a retrospective study

Zhu¹,

Zheng²,

Shen³

et al. 2020

Preprint

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Background: Adrenocortical Carcinoma (ACC) is a rare and highly malignant tumor with a high recurrence rate. Reoperation to attain negative resection margin is recommended for selected patients. However, there is limited data on the outcome of unresectable recurrent tumor treated with palliative radiotherapy (RT) and transhepatic arterial embolization (TAE).Method: A retrospective analysis of the Peking Union Medical College Hospital was conducted. Patients with pathologically con rmed ACC were included.Result: Ninety-two patients ful lled the criteria. The 5-year, 3-year, 1-year overall survival (OS) rates were 27.2%, 44.6% and 71.7% respectively, and median OS was 32.1 months. Age < 50 years, ENSAT stage I/II, surgery and negative surgical margin were associated with improved OS (all P <0.05). A Ki67 index < 20% was a predictor of better disease-free interval (P =0.011). Of 51 patients with recurrent ACC, local treatment (reoperation, palliative RT and TAE) improved OS after recurrence from 14.5 months to 41.6 months. Local therapy and mitotane were both prognostic factors for improved OS after recurrence.Conclusion: multidisciplinary treatment is the major therapeutic approach for ACC. Resectable cases should receive complete resection to attain negative margin. Local treatment such as palliative RT and TAE may extend OS for unresectable recurrence. 23 (45.1) 27.07 0.448 0.046

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Surgery for recurrent adrenocortical carcinoma: A multicenter retrospective study

Cited by 27 publications

References 24 publications

European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors

European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors

Treatment and management of adrenal cancer in a specialized Australian endocrine surgical unit: approaches, outcomes and lessons learnt

Outcome of multidisciplinary management of adrenocortical carcinoma: a retrospective study

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