Improvement in Recurrence-free Survival with Adjuvant Radiation in Adrenocortical Carcinoma

2018 ◽  
Vol 102 (3) ◽  
pp. e90-e91
Author(s):  
L.A. Gharzai ◽  
M. Green ◽  
K. Griffith ◽  
T. Else ◽  
D.E. Spratt ◽  
...  
Keyword(s):  
Adrenocortical Carcinoma ◽  
Adjuvant Radiation ◽  
Recurrence Free Survival ◽  
Free Survival

scholarly journals Adjuvant Radiation Improves Recurrence-Free Survival and Overall Survival in Adrenocortical Carcinoma

2019 ◽  
Vol 104 (9) ◽  
pp. 3743-3750 ◽  
Author(s):  
Laila A Gharzai ◽  
Michael D Green ◽  
Kent A Griffith ◽  
Tobias Else ◽  
Charles S Mayo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adrenocortical Carcinoma ◽  
Adjuvant Radiation ◽  
Recurrence Free Survival ◽  
University Of Michigan ◽  
Free Survival ◽  
Tumor Bed ◽  
Distant Failure ◽  
Rare Malignancy ◽  
The University

Abstract Context Adrenocortical carcinoma (ACC) is a rare malignancy with high rates of recurrence and poor prognosis. The role of radiotherapy (RT) in localized ACC has been controversial, and RT is not routinely offered. Objective To evaluate the benefit of adjuvant RT on outcomes in ACC. Design This is a retrospective propensity-matched analysis. Setting All patients were seen through the University of Michigan’s Endocrine Oncology program, and all those who underwent RT were treated at the University of Michigan. Participants Of 424 patients with ACC, 78 were selected; 39 patients underwent adjuvant radiation. Intervention Adjuvant RT to the tumor bed and adjacent lymph nodes. Main Outcomes Measures Time to local failure, distant failure, or death. Results Median follow-up time was 4.21 years (95% CI, 2.79 to 4.94). The median radiation dose was 55 Gy (range, 45 to 60). The 3-year overall survival estimate for patients improved from 48.6% for patients without RT (95% CI, 29.7 to 65.2) to 77.7% (95% CI, 56.3 to 89.5) with RT, with a hazard ratio (HR) of 3.59 (95% CI, 1.60 to 8.09; P = 0.002). RT improved local recurrence-free survival (RFS) from 34.2% (95% CI, 18.8 to 50.3) to 59.5% (95% CI, 39.0 to 75.0), with an HR of 2.67 (95% CI, 1.38 to 5.19; P = 0.0035). RT improved all RFS from 18.3% (95% CI, 6.7 to 34.3) to 46.7% (95% CI, 26.9 to 64.3), with an HR 2.59 (95% CI, 1.40 to 4.79; P = 0.0024). Conclusions In the largest single institution study to date, adjuvant RT after gross resection of ACC improved local RFS, all RFS, and overall survival in this propensity-matched analysis. Adjuvant RT should be considered a part of multidisciplinary management for patients with ACC.

The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas

2011 ◽  
Vol 14 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Samuel T. Chao ◽  
Taisei Kobayashi ◽  
Edward Benzel ◽  
Chandana A. Reddy ◽  
Glen H. J. Stevens ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Survival Time ◽  
Median Time ◽  
Salvage Therapy ◽  
Karnofsky Performance Scale ◽  
Adjuvant Radiation ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Initial Recurrence

Object The goal in this study was to determine the role of radiation therapy (RT) in the treatment of spinal myxopapillary ependymomas (MPEs). Methods Thirty-seven patients with histologically verified spinal MPEs were reviewed. Kaplan-Meier analyses and Cox proportional hazard regression were used to determine what patient and treatment factors influenced overall survival (OS) and recurrence. Results At the time of initial diagnosis, the median age was 33 years and the Karnofsky Performance Scale score was 80. In 86.5% of cases, the most common presenting symptom was pain. All patients received surgery as their initial treatment. Nine patients also received RT along with surgery, with a median total dose of 50.2 Gy. The mean survival time was 12.2 years; however, only 4 of 37 patients had died at the time of this study. None of the patient or treatment parameters significantly correlated with OS. Sixteen patients (43.2%) were found to have a recurrence, with a median time to recurrence of 7.7 years. None of the patient or treatment parameters correlated with recurrence-free survival for an initial recurrence. The median time to the second recurrence (recurrence following therapy for initial recurrence) was 1.6 years. Use of RT as salvage therapy after initial recurrence significantly correlated with longer times to a second recurrence. The median recurrence-free survival time before the second recurrence was 9.6 years for those who received RT versus 1.1 years for those who did not receive RT (p = 0.0093). None of the other parameters significantly correlated with a second recurrence. Conclusions Radiation therapy may have a role as salvage therapy in delaying recurrences of spinal MPEs.

Adjuvant radiotherapy after primary surgical resection in patients with adrenocortical carcinoma: Retrospective cohort analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4641-4641
Author(s):  
Mouhammed Amir Habra ◽  
Shamim Ejaz ◽  
Lei Feng ◽  
Prajnan Das ◽  
Ferhat Deniz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Adrenocortical Carcinoma ◽  
Adjuvant Radiotherapy ◽  
Distant Recurrence ◽  
Hazard Ratio ◽  
Control Group ◽  
Recurrence Free Survival ◽  
Free Survival

4641 Background: Adrenocortical carcinoma (ACC) is a rare malignancy with high recurrence and mortality rates. The role of adjuvant radiotherapy (RT) to improve outcome remains unclear. Considering the rarity of ACC, we conducted a historical cohort study to ascertain the effect of adjuvant RT on overall survival and recurrence rates. Methods: Patients were selected from the MD Anderson Cancer Center (MDACC) ACC registry (1998- 2011) who had primary tumor resection with no evidence of distant metastasis at the time of initial diagnosis and a minimum follow-up of 6-months. The adjuvant RT group included patients who received adjuvant RT within 3 months of diagnosis. Control group included patients who did not receive RT and matched based on resection margin status and stage at diagnosis. Results: There were no significant differences between the adjuvant RT group (n=15) and comparison group (n =45) in gender distribution, age, tumor size, functional status, and use of adjuvant mitotane therapy. On multivariate Cox proportional hazard model for overall survival, the adjuvant RT group had hazard ratio of 1.981(95% confidence interval [CI] 0.894-4.391, p=0.0922) compared to the control group. The differences in median time to local recurrence, distant recurrence and of recurrence free survival were not significant between the two groups. In subgroup analysis including only the patients whose initial treatments were from outside of MDACC, RT group (n=15) had hazard ratio of overall survival of 1.604 (95% CI 0.712- 3.613, p=0.2543) compared to group without adjuvant RT (n= 32). Median times to local recurrence, distant recurrence, or of recurrence free survival were also not significantly different between the two groups. Conclusions: To our knowledge, this is the largest single institution report about adjuvant RT use in ACC. In our study, RT did not appear to cause a significant difference in overall survival, recurrence rate, or time to recurrence. However, it is still possible that patients offered adjuvant RT and control groups may have been inherently different. Hence, a prospective study is needed to clarify the role of adjuvant RT in patients with resectable ACC.

scholarly journals Benefits of Adjuvant Mitotane after Resection of Adrenocortical Carcinoma: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Yongquan Tang ◽  
Zhihong Liu ◽  
Zijun Zou ◽  
Jiayu Liang ◽  
Yiping Lu ◽  
...  
Keyword(s):  
Distant Metastasis ◽  
Adrenocortical Carcinoma ◽  
Retrospective Studies ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Review Current

Background. The adjuvant use of mitotane on adrenocortical carcinoma (ACC) has always been in controversy. We aimed to assess the prognostic benefits of adjuvant mitotane after resection of ACC in patients without distant metastasis.Methods. The PubMed, WoS, Embase, and Cochrane Library databases were systematically searched. Recurrence-free survival (RFS) and overall survival (OS) were adopted as measurements. A meta-analysis was conducted based on hazard ratio (HR) with 95% confidence interval (CI). A study was included only if the enrolled patients underwent resection of ACC without adjuvant chemotherapy except mitotane.Results. A total of 5 retrospective studies reporting on 1249 patients were included for this meta-analysis. The meta-analysis showed that adjuvant mitotane was significantly associated with prolonged RFS (HR = 0.62; 95%CI, 0.42-0.94; P < 0.05) and prolonged OS (HR = 0.69; 95%CI, 0.55-0.88, P < 0.05).Conclusion. After comprehensive review, current evidence suggests that adjuvant mitotane significantly decreases the recurrence rate and mortality after resection of ACC in patients without distant metastasis, but these findings need further demonstration from prospective controlled trials.

scholarly journals A Case of Spontaneously Ruptured Adrenocortical Carcinoma that Achieved 24-months Recurrence-free Survival

2017 ◽  
Vol 78 (6) ◽  
pp. 1415-1420
Author(s):  
Yosuke MIYACHI ◽  
Takahiro MURAKAMI ◽  
Masafumi IE ◽  
Kazuya SUNAGAWA ◽  
Makoto UEDA ◽  
...  
Keyword(s):  
Adrenocortical Carcinoma ◽  
Recurrence Free Survival ◽  
Free Survival

Increased risk of recurrence in early-stage endometrial carcinoma after delays in adjuvant radiation treatment

2020 ◽  
Vol 31 (1) ◽  
pp. 73-77
Author(s):  
Simeng Zhu ◽  
Remonda Khalil ◽  
Osama Altairy ◽  
Charlotte Burmeister ◽  
Irina Dimitrova ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endometrial Carcinoma ◽  
Radiation Treatment ◽  
Early Stage ◽  
Time Interval ◽  
Adjuvant Radiation ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Adjuvant Radiation Therapy ◽  
Disease Specific

ObjectiveThe benefits of adjuvant radiation treatment after hysterectomy have been confirmed in select patients with early-stage endometrial carcinoma. The goal of this study was to evaluate the prognostic impact of the time interval between hysterectomy and starting adjuvant radiation treatment in patients with early-stage endometrial carcinoma.MethodsOur database was searched for women with early-stage endometrioid endometrial cancer who received adjuvant radiation therapy after hysterectomy. The patients were classified into two groups based on the time interval to adjuvant radiation therapy (≤8 weeks or >8 weeks) after hysterectomy. Recurrence-free survival, disease-specific survival, and overall survival were compared between the two groups.ResultsFour hundred and sixty patients were identified. Median follow-up was 70.5 months (range 1–360). One hundred and seventy-six patients (38%) were 2009 International Federation of Gynecology and Obstetrics stage IA, 207 (45%) stage IB, and 77 (17%) stage II. Three hundred and fifty-four women (77%) received adjuvant radiation therapy within 8 weeks after hysterectomy. There was no statistically significant difference between the two groups in baseline demographics, disease and treatment characteristics, except for the modality of adjuvant radiation therapy. Patients who received adjuvant radiation therapy within 8 weeks experienced significantly less disease recurrence (9% vs 18%; p=0.01) and particularly less isolated vaginal recurrence (0% vs 6%, p=0.04). Five-year recurrence-free survival was 89% versus 80% (p=0.04), 5-year disease-specific survival was 93% for both groups, and 5-year overall survival was 86% versus 85% for patients who received adjuvant radiation therapy ≤8 and >8 weeks, respectively (p=0.88).ConclusionOur study suggests that delaying adjuvant radiation therapy beyond 8 weeks after hysterectomy is associated with significantly more cancer recurrences for women with early-stage endometrial carcinoma.

scholarly journals Influence of hormonal functional status on survival in adrenocortical carcinoma: systematic review and meta-analysis

2018 ◽  
Vol 179 (6) ◽  
pp. 429-436 ◽  
Author(s):  
T Vanbrabant ◽  
M Fassnacht ◽  
G Assie ◽  
O M Dekkers
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Adrenocortical Carcinoma ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Future Research ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Hormonal Secretion

Objective Adrenocortical carcinoma (ACC) is a malignancy with a poor prognosis. Many publications in ACC report on risk factors for a poor outcome; one risk factor studied is hormonal hypersecretion (cortisol, sex-hormones, steroid precursors or aldosterone). The aim of this systematic review was to study the association between hormonal secretion and recurrence or mortality in ACC. Design Systematic review and meta-analysis. We searched PubMed, EMBASE and The Cochrane library (January 2018) for cohort studies examining the association between hormonal secretion on overall or recurrence-free survival in ACC. Methods A random-effects model meta-analysis was performed to obtain a weighted relative risk comparing cortisol-secreting and/or androgen-secreting ACCs to non-secreting tumours regarding overall and recurrence-free survival. Risk of bias assessment was performed for all studies included. Results Nineteen publications were included representing a total of 3814 patients. Most studies were generally considered low/intermediate risk of bias. Meta-analysis showed higher mortality risk for cortisol-secreting ACCs, weighted relative risk 1.71 (95% CI: 1.18–2.47) combining studies that adjusted for tumour stage; also a higher recurrence risk was found for cortisol producing ACCs, relative risk 1.43 (95% CI: 1.18–1.73). Androgen secretion was not clearly associated with survival (RR: 0.82, 95% CI: 0.60–1.12). Conclusion This systematic review and meta-analysis show that cortisol-secreting ACCs are associated with a worse overall survival; future research is needed to establish whether this association points to negative effects of cortisol action, whether it signifies a more aggressive ACC subtype or whether cortisol is merely a prognostic marker.

scholarly journals Recurrence-free survival following aggressive multimodal treatment of an isolated recurrence of adrenocortical carcinoma

2021 ◽  
pp. IJE32
Author(s):  
Alexander Magony ◽  
Adam Mutsaers ◽  
Belal Ahmad
Keyword(s):  
Adrenocortical Carcinoma ◽  
Adjuvant Radiation ◽  
Recurrence Rates ◽  
Complete Excision ◽  
Free Survival ◽  
Aggressive Management ◽  
Drop Metastasis ◽  
Potential Benefits ◽  
Previously Treated

A 43-year old woman demonstrated an intra-abdominal drop metastasis 6 years after initial presentation of stage-III adrenocortical carcinoma (ACC), previously treated with resection, adjuvant radiation and mitotane therapy. This recurrence was managed aggressively with complete excision, adjuvant radiation and mitotane. Imaging at 3.25-year follow-up showed no evidence of recurrence, a remarkable response given ACC’s poor prognosis and high recurrence rates. Management of oligometastatic ACC remains unclear and intra-abdominal drop metastases are particularly rare in ACC; both require further documentation. Aggressive management with adjuvant radiation and mitotane therapy may represent an effective and well-tolerated approach for improving local control for recurrent ACC, including drop metastases. Further research is required to codify potential benefits.

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