Long-term survival and disease regression after adrenalectomy for adrenal metastases from melanoma

Abstract

7540 Background: Human melanoma cells express high affinity glucocorticoid receptors, and adrenalectomy has been shown to have anti-melanoma effects in animal models. We observed long-term regression of metastatic melanoma in two patients following bilateral adrenalectomy, prompting a review of adrenalectomy at the Sydney Melanoma Unit (SMU). Methods: All SMU patients having adrenalectomy for melanoma metastatic to the adrenal gland(s) between January 1987 and June 2001 were identified and examined. Results: 17 patients underwent adrenalectomy for adrenal metastases, 5 females and 12 males, median age 62 years. The adrenal gland(s) were the sole site of disease in 13 patients. Indications were pain (n=4), or the detection of bulky metastases on radiological imaging (n=13). Five patients had bilateral adrenal metastases resected. Significant post-operative morbidity occurred in 2 patients (12%), but there was no post-operative mortality. The median survival of patients after adrenalectomy was 19 months (2 year survival 46%), compared with 4 months for patients with documented adrenal metastases concurrently treated with best supportive care (n=127) (p=0.0001). In two patients non-resected metastases elsewhere regressed following bilateral adrenalectomy, and both remain disease free over three years later. Conclusion: As previously reported, adrenalectomy for adrenal melanoma metastases is associated with prolonged survival in selected patients. We report for the first time sustained complete regression of distant metastatic melanoma following adrenalectomy, suggesting a possible role for adrenal hormones in modifying melanoma in certain patients. No significant financial relationships to disclose.