Yttrium-90 Selective Internal Radiation Therapy Plus Cryoablation for Recurrent Adrenocortical Carcinoma With Liver Metastases

Abstract

Advanced adrenocortical carcinoma (ACC) has a poor prognosis and is often resistant to the conventional regimens of mitotane administration and systemic chemotherapy. In addition to surgery, local therapeutic measures can be valuable. Here, we present the case of a 33-year-old woman who developed left retroperitoneal local recurrent ACC with hepatic and pulmonary metastases one year after radical adrenalectomy. The tumors progressed under chemotherapy and mitotane treatments. She was treated with yttrium90 selective internal radiation therapy ( 90Y SIRT) for hepatic metastases and cryoablation of the local recurrent tumor, after which significant tumor shrinkage was observed. She then received radiofrequency ablation for the residual hepatic metastases and radiotherapy to the residual local recurrent tumor. Complete remission was achieved and maintained at least until the data cutoff day (15.8 months after the last treatment). This is the first published report of cryoablation in a patient with ACC and the third report of 90Y SIRT use for hepatic metastasis of ACC. Cryoablation and 90Y SIRT are local treatment choices for ACC that are worthy of further study.

High-Dose Rate Brachytherapy Combined with PD-1 Blockade as a Treatment for Metastatic Adrenocortical Carcinoma – A Single Center Case Series

“…While evidence is accumulating for the use of locoregional therapies such as cryoablation [25] or radiofrequency ablation [26] in oligometastatic ACC, experience with HDR-BT in ACC has not been reported to our knowledge. Our case series demonstrates the favorable local outcome of this interventional method with complete or partial remission observed in all treated metastases.…”

Adrenocortical carcinoma: selective internal radiation therapy and liver metastases

“…In all previously reported cases of 90 Y SIRT use in liver metastases, systemic chemotherapy has also been employed, most commonly in the form of mitotane with (Lin et al, 2022;Pigg et al, 2020;Makary et al, 2018) or without (Lu et al, 2021) etoposide, doxorubicin and cisplatin (EDP). Several of these cases report a complete radiological response to liver SIRT, as long as 24 months post-treatment (Lin et al, 2022;Makary et al, 2018;Pigg et al, 2020). In one case, a complete pathological response was also reported, as assessed by a consolidatory partial hepatectomy 7 months post-SIRT (Lu et al, 2021).…”

“…There is established evidence regarding the use of β-emitter yttrium-90 ( 90 Y) SIRT for liver metastases in neuroendocrine tumours (NETs), with its efficacy and low toxicity profile well discussed (Barbier et al, 2016). Literature specific to the use of SIRT for ACC liver metastases is, however, very limited; four case reports (Lin et al, 2022;Pigg et al, 2020;Makary et al, 2018;Lu et al, 2021) discuss SIRT in this setting, and one small case series describes increased survival in patients undergoing either SIRT or transcatheter arterial chemoembolization (TACE) (Owen et al, 2019).…”

The Value of Local Therapies in Advanced Adrenocortical Carcinoma

“…In these 11 studies, which included 200 patients, RT was performed as a treatment for irresectable or not completely resectable tumours/metastases, as a therapy for pain, or for the prevention of complications from metastases [10,[30][31][32][33][34][35][36][37][38][39][40]. However, at present, only nine studies and a few case reports involving a total of only 170 patients have been published on different types of LT beyond radiotherapy [28,31,[41][42][43][44][45][46][47][48][49][50]. The largest of these studies is from Cazejust et [31,41,43,44].…”