Adjuvant radiotherapy for the primary treatment of adrenocortical carcinoma: Are we offering the best?

Vol. 43 (x): 2017 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0095


ORIGINAL ARTICLE

Victor Srougi 1, Jose Bessa Junior 2, Fabio Y. Tanno 1, Amanda M. Ferreira 3, Ana O. Hoff 4, João E. Bezerra 4, Cristiane M. Almeida 5, Madson Q. Almeida 3, 4, Berenice B. Mendonça 3, William C. Nahas 1, Jose L. Chambô 1, Miguel Srougi 1, Maria C. B. V. Fragoso 3, 4
1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 2 Divisão de Urologia, Universidade de Feira de Santana, BA, Brasil; 3 Unidade de Suprerrenal da Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, Brasil; 4 Divisão de Endocrinologia do Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 5 Divisão de Radioterapia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

 

ABSTRACT

Purpose: To evaluate the role of ARDT after surgical resection of ACC.

Materials and Methods: Records of patients from our institutional ACC database were retrospectively assessed. A paired comparison analysis was used to evaluate the onco­logical outcomes between patients treated with surgery followed by ARDT or surgery only (control). The endpoints were LRFS, RFS, and OS. A systematic review of the literature and meta-analysis was also performed to evaluate local recurrence of ACC when ARDT was used.

Results: Ten patients were included in each Group. The median follow-up times were 32 months and 35 months for the ARDT and control Groups, respectively. The re­sults for LRFS (p=0.11), RFS (p=0.92), and OS (p=0.47) were similar among subsets. The mean time to present with local recurrence was significantly longer in the ARDT group compared with the control Group (419±206 days vs. 181±86 days, respectively; p=0.03). ARDT was well tolerated by the patients; there were no reports of late toxicity. The meta-analysis, which included four retrospective series, revealed that ARDT had a protective effect on LRFS (HR=0.4; CI=0.17-0.94).

Conclusions: ARDT may reduce the chance and prolong the time to ACC local recur­rence. However, there were no benefits for disease recurrence control or overall sur­vival for patients who underwent this complementary therapy.

 

Keywords: Adrenocortical Carcinoma; Radiotherapy, Adjuvant; Therapeutics

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