Source: DGNews  |  Posted 1 year ago

By Jill Stein

ST. LOUIS, Mo -- March 7, 2010 -- Given the absence of effective systemic treatment options, liver resection, and radiofrequency ablation (RFA) may be considered for selected patients with adrenocortical carcinoma (ACC) metastatic to the liver who have a disease-free interval exceeding 9 months, researchers said here on March 6 at the 2010 Society of Surgical Oncology Annual Cancer Symposium (SSO).

R. Taylor Ripley, MD, National Cancer Institute (NCI), Bethesda, Maryland, and colleagues reviewed data in patients who underwent liver resection and RFA for ACC from 1979 to 2009. Their data are from the largest reported series of liver resection and RFA for ACC.

Adrenocortical carcinoma is a rare disease with an annual incidence of .5 to 2 cases per million population and is responsible for roughly 0.2% of all cancer deaths in the United States, according to Dr. Ripley.

Surgery remains the most effective treatment option and complete resection is the most “consistently cited” prognostic factor for long-term survival, he added.

Despite complete resection, however, up to 85% of patients will develop recurrences locally or distantly, which may partially explain the poor 5-year survival. Chemotherapy is frequently given but with minimal effect.

The investigators undertook the present study to review their experience with liver resection of metastatic ACC to the liver.

Of 27 patients in their review, 19 underwent liver resection. Of the 19 patients, 18 were rendered disease-free in the liver and 11 were rendered completely free of disease.

Of the 13 patients who had synchronous extrahepatic disease, 10 underwent synchronous hepatic resection. Five of these 10 patients were rendered disease free.

At a median potential follow-up of 6.2 years, 6 (35%) of 17 patients remained disease-free in the liver.

Seven of 8 patients who underwent RFA became disease free in the liver.

No patient responded to previous chemotherapy.

The median overall survival and survival of patients who underwent liver resection or RFA were both 1.9 years. The 5-year actuarial survivals were 29% each.

Patients with a disease-free interval >9 months from primary resection had a median survival of 4.1 years versus 0.9 years in patients with a disease-free survival <9 months.

“Metastatic resection of liver lesions is technically feasible,” Dr. Ripley said. “While most patients will recur, 35% may achieve long-term control of hepatic disease and median survival approaches 2 years after resection.”

While cure of ACC is rare, the lack of effective systemic agents and the association of complete resections with prolonged survival means that liver resection or RFA for the treatment of liver metastases is a reasonable option, he added. This is especially true for patients with a disease-free interval >9 months.

[Presentation title: Liver Resection for Metastatic Adrenocortical Carcinoma. Abstract P140]