The role of multimodal salvage therapy in the management of recurrent adrenocortical carcinoma.

Autor:	Kijima T; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Fukuda S; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Fukushima H; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Uehara S; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Yasuda Y; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Yoshida S; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Yokoyama M; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Matsuoka Y; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Saito K; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Fujii Y; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
Jazyk:	angličtina
Zdroj:	Japanese journal of clinical oncology [Jpn J Clin Oncol] 2023 Apr 29; Vol. 53 (5), pp. 436-442.
DOI:	10.1093/jjco/hyac207
Abstrakt:	Background: Adrenocortical carcinoma is an aggressive tumor which often recurs despite apparent complete resection. This study assessed the long-term outcomes for patients with recurrent adrenocortical carcinoma after multimodal salvage therapy with chemotherapy, chemoradiotherapy and surgery. Methods: We retrospectively reviewed medical records of patients who had a pathological diagnosis of adrenocortical carcinoma between 1996 and 2017. Kaplan-Meier curves were used to assess progression-free and cancer-specific survivals among all patients and cancer-specific survival among patients with tumor recurrence. Log-rank test was used to compare patient survivals by modality of salvage therapy (chemotherapy, chemoradiotherapy and chemotherapy/chemoradiotherapy plus surgery). Results: Of 20 patients who underwent initial surgery, recurrence occurred in 14 (70%) with a median interval of 7.5 (range 1.0-12.6) months. Salvage therapy provided was chemotherapy only (n = 7), chemoradiotherapy (n = 2) and chemotherapy/chemoradiotherapy plus surgery (n = 5). Of the five patients who received salvage surgery, three underwent repeated resections. The potential benefit of multimodal salvage therapy was suggested in five patients (4 with chemotherapy/chemoradiotherapy plus surgery and 1 with chemoradiotherapy) who achieved durable disease control (cancer-specific survival from initial recurrence, 22-258 months). With a median follow-up of 25 months from recurrence, the 5-year cancer-specific survival rate was 58%. cancer-specific survival after recurrence was prolonged in patients with ≤ stage 3 disease, positive response to chemotherapy/chemoradiotherapy and salvage surgery. Conclusions: Long-term disease control and survival could be achieved in highly selected patients with recurrent adrenocortical carcinoma using a multidisciplinary approach. Patients who had relatively limited recurrent sites and responded well to chemotherapy/chemoradiotherapy may be considered for salvage surgery on a case-by-case basis. (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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