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Adjunctive treatment of adrenocortical carcinoma

Terzolo, Massimoa; Berruti, Alfredob

Current Opinion in Endocrinology, Diabetes & Obesity: June 2008 - Volume 15 - Issue 3 - p 221–226
doi: 10.1097/MED.0b013e3282fdf4c0
Adrenal cortex: Edited by Robert Dluhy

Purpose of review: Description of the adjunctive treatment strategies in patients with adrenocortical carcinoma after complete surgical resection.

Recent findings: A retrospective analysis showing that adjuvant mitotane may prolong recurrence-free survival in a large cohort of patients with radically resected adrenocortical carcinoma has recently been published. Debate continues as to whether mitotane may, however, be beneficial as an adjuvant treatment.

Summary: Radical surgical resection of adrenocortical carcinoma offers the best chance for prolonged recurrence-free survival; however, a significant number of patients without objective and biochemical evidence of residual tumor after surgery are destined to relapse. Mitotane, an analogue of the insecticide dichlorodiphenyltrichloroethane, has been used for treatment of advanced adrenocortical carcinoma since the 1960s, but its use as an adjunctive postoperative measure has remained controversial. Adjunctive treatments different from mitotane have been employed infrequently; a recent retrospective study showed benefit of local radiotherapy. The recent demonstration that mitotane treatment following macroscopically complete removal of adrenocortical carcinoma was associated with beneficial effects on outcome in a well designed, multicenter, international study should renew interest in adjuvant mitotane therapy.

aDepartment of Clinical and Biological Sciences, Internal Medicine, Italy

bDepartment of Clinical and Biological Sciences, Medical Oncology, University of Turin, Turin, Italy

Correspondence to Professor M. Terzolo, MD, Medicina Interna I, A.S.O. San Luigi, Regione Gonzole, 10, 10043 Orbassano, Italy Tel: +39 011 9026292; fax: +39 011 9038655; e-mail: terzolo@usa.net

© 2008 Lippincott Williams & Wilkins, Inc.