BERKELEY, CA (UroToday.com) - The increasing use of body imaging has incidentally identified many adrenal tumors, including adrenocortical carcinomas (which are rare), and has led to an increase in the number of adrenal surgeries. It is estimated that two-thirds of adrenal surgeries in the U.S. are done in hospitals that perform fewer than 6 adrenal surgeries per year. Our institution’s published experience and recent data from Europe found improved outcomes in patients treated in major referral centers known to have experience treating adrenocortical carcinoma. Multiple factors complicate the generalization of experience reported from major tertiary referral centers to practice in community setting, especially for such a rare disease. In particular, selection bias and limited access to highly skilled clinical experts are key factors that may affect these patients’ outcomes.
Our recently published data about adjuvant radiation therapy for adrenocortical carcinoma do not justify its routine use after the first surgical resection. At the same time, we acknowledge that factors we did not evaluate (e.g., possible markers of cell proliferation) may indicate radiation therapy in selected individuals. The retrospective nature of our study and the inherent bias in such a design should be considered while interpreting the study’s results. As we stated in that publication, prospective studies are needed to identify patients who might benefit from radiation therapy after resection.
In addition, we note that adrenocortical carcinoma is a systemic disease in most patients and that distant recurrence is the most common scenario -- even after complete surgical resection. Thus, we cannot advocate routine use of a localized treatment such as radiotherapy to treat a disease that will likely recur in distant organs. Still, some adrenocortical carcinoma patients display a pattern of only localized disease recurrence that requires repeated surgeries. In such patients, radiation therapy may have a role in reducing the risk of future local recurrence, but predictive factors (e.g., genomic features) that identify this subgroup of patients have not yet been determined. In addition, radiation therapy is still indicated to treat symptomatic metastases, especially those in bone.
Mouhammed Amir Habra, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Endocrine, Neoplasia, and Hormonal Disorders
The University of Texas MD Anderson Cancer Center
Houston, TX USA