Response to mitotane predicts outcome in patients with recurrent adrenal cortical carcinoma.

Abstract

BACKGROUND:

Adrenal cortical carcinoma (ACC) is a rare disease in which recurrence after surgery is common. Mitotane is the primary systemic treatment for recurrent ACC; data are limited regarding the impact of mitotane on recurrent ACC.

METHODS:

We reviewed the records of all patients who underwent surgery for ACC evaluated at our institution from 1991 to 2006.

RESULTS:

The median disease-free survival for all 186 patients was 12 months and the median overall survival (OS) was 37 months. Higher stage at presentation (P = .002) and tumor cortisol production (P = .007) were associated with a worse OS. Mitotane was given to 67 evaluable patients with recurrent ACC. A response to mitotane was observed in 13 (19%) of the 67 patients. For patients with stable or responding disease to mitotane, the median OS from date of recurrence was 18 months, compared with 9 months (P = .01) for those who progressed.

CONCLUSIONS:

Patients with recurrent ACC who have stable or responding disease to mitotane have a more favorable prognosis than those who progress. Mitotane should be considered in most patients with recurrent ACC, including as preoperative therapy for those with recurrent disease considered for surgical resection.

• Authors: Ricardo J Gonzalez, Eric P Tamm, Chaan Ng, Alexandria T Phan, Rena Vassilopoulou-Sellin, Nancy D Perrier, Douglas B Evans, Jeffrey E Lee
• Journal: Surgery (Surgery) Vol. 142 Issue 6 Pg. 867-75; discussion 867-75 (Dec 2007) ISSN: 1532-7361 [Electronic] United States
• PMID: 18063070 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents, Hormonal
• Mitotane

Topics

• Adolescent
• Adrenal Cortex Neoplasms (drug therapy, surgery)
• Adult
• Aged
• Antineoplastic Agents, Hormonal (therapeutic use)
• Child
• Child, Preschool
• Combined Modality Therapy
• Disease-Free Survival
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Mitotane (therapeutic use)
• Neoplasm Recurrence, Local (drug therapy, surgery)
• Predictive Value of Tests
• Prognosis