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J Clin Endocrinol Metab. 2019 Sep 1;104(9):3743-3750. doi: 10.1210/jc.2019-00029.

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

Author information

1
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
2
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
3
Department of Endocrinology, University of Michigan, Ann Arbor, Michigan.
4
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
5
Department of Radiation Oncology, Kaiser Permanente, Portland, Oregon.
6
Department of Surgery, University of Michigan, Ann Arbor, Michigan.
7
Department of Internal Medicine, Division of Medical Oncology, University of Michigan, Ann Arbor, Michigan.
8
Department of Pathology, University of Michigan, Ann Arbor, Michigan.

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.

PMID:
31220287
DOI:
10.1210/jc.2019-00029

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