Abstract
A relevant issue on the treatment of adrenocortical carcinoma (ACC) concerns the optimal duration of adjuvant mitotane treatment. We tried to address this question, assessing whether a correlation exists between the duration of adjuvant mitotane treatment and recurrence-free survival (RFS) of patients with ACC. We conducted a multicenter retrospective analysis on 154 ACC patients treated for ≥12 months with adjuvant mitotane after radical surgery and who were free of disease at the mitotane stop. During a median follow-up of 38 months, 19 patients (12.3%) experienced recurrence. We calculated the RFS after mitotane (RFSAM), from the landmark time-point of mitotane discontinuation, to overcome immortal time bias. We found a wide variability in the duration of adjuvant mitotane treatment among different centers and also among patients cared for at the same center, reflecting heterogeneous practice. We did not find any survival advantage in patients treated for longer than 24 months. Moreover, the relationship between treatment duration and the frequency of ACC recurrence was not linear after stratifying our patients in tertiles of length of adjuvant treatment. In conclusion, the present findings do not support the concept that extending adjuvant mitotane treatment over two years is beneficial for ACC patients with low to moderate risk of recurrence.
Highlights
Adrenocortical carcinoma (ACC) is a rare tumor characterized by an aggressive disease course that limits long-term survival [1–3]
We have addressed the challenging issue of identifying the optimal duration of adjuvant mitotane therapy in a retrospective analysis
With all the disclosed limits of our study, the present findings do not support the concept that extending adjuvant mitotane treatment over two years is beneficial for patients with adrenocortical carcinoma (ACC) at low risk of recurrence
Summary
Adrenocortical carcinoma (ACC) is a rare tumor characterized by an aggressive disease course that limits long-term survival [1–3]. Use of adjuvant mitotane increased in clinical practice following the observation that adjuvant mitotane treatment was associated with prolonged recurrencefree survival (RFS) compared to surveillance without active treatment after surgery, in a retrospective study of 177 ACC patients managed at different institutions using either adjuvant mitotane or no treatment. In this cohort study, we included 47 patients followed at Italian reference centers that systematically adopted adjuvant mitotane to all radically operated ACC, and a group of 55 Italian patients and 75 German patients followed in centers not giving any post-operative treatment [12]. Critics of adjuvant mitotane therapy evoke the drug-related toxicity, the complexity of caring for patients on treatment, and the long duration of a treatment course [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
