The Value of Local Therapies in Advanced Adrenocortical Carcinoma

International guidelines recommend local therapies (LTs) such as local thermal ablation (LTA; radiofrequency, microwave, cryoablation), transarterial (chemo)embolisation (TA(C)E), and transarterial radioembolisation (TARE) as therapeutic options for advanced adrenocortical carcinoma (ACC). However,...

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Bibliographic Details
Published in:Cancers 2024-02, Vol.16 (4), p.706
Main Authors: Kimpel, Otilia, Altieri, Barbara, Laganà, Marta, Vogl, Thomas J, Adwan, Hamzah, Dusek, Tina, Basile, Vittoria, Pittaway, James, Dischinger, Ulrich, Quinkler, Marcus, Kroiss, Matthias, Puglisi, Soraya, Cosentini, Deborah, Kickuth, Ralph, Kastelan, Darko, Fassnacht, Martin
Format: Article
Language:English
Subjects:
Ablation
Ablation (Surgery)
Antimitotic agents
Antineoplastic agents
Cancer
Carcinoma
Care and treatment
Case reports
Catheters
Chemotherapy
Cohort analysis
Disease control
General anesthesia
Health aspects
Lesions
Local anesthesia
Medical prognosis
Metastases
Metastasis
Patients
Plasma levels
Radiation therapy
Remission
Surgery
Survival
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Summary:International guidelines recommend local therapies (LTs) such as local thermal ablation (LTA; radiofrequency, microwave, cryoablation), transarterial (chemo)embolisation (TA(C)E), and transarterial radioembolisation (TARE) as therapeutic options for advanced adrenocortical carcinoma (ACC). However, the evidence for these recommendations is scarce. We retrospectively analysed patients receiving LTs for advanced ACC. Time to progression of the treated lesion (tTTP) was the primary endpoint. The secondary endpoints were best objective response, overall progression-free survival, overall survival, adverse events, and the establishment of predictive factors by multivariate Cox analyses. A total of 132 tumoural lesions in 66 patients were treated with LTA (n = 84), TA(C)E (n = 40), and TARE (n = 8). Complete response was achieved in 27 lesions (20.5%; all of them achieved by LTA), partial response in 27 (20.5%), and stable disease in 38 (28.8%). For the LTA group, the median tTTP was not reached, whereas it was reached 8.3 months after TA(C)E and 8.2 months after TARE ( < 0.001). The median time interval from primary diagnosis to LT was >47 months. Fewer than four prior therapies and mitotane plasma levels of >14 mg/L positively influenced the tTTP. In summary, this is one of the largest studies on LTs in advanced ACC, and it demonstrates a very high local disease control rate. Thus, it clearly supports the guideline recommendations for LTs in these patients.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers16040706