Efficacy and safety of radiation therapy in advanced adrenocortical carcinoma

Otilia Kimpel, Paul Schindler, Laura Schmidt-Pennington, Barbara Altieri, Felix Megerle, Harm Haak, James Pittaway, Ulrich Dischinger, Marcus Quinkler, Knut Mai, Matthias Kroiss, Bülent Polat, Martin Fassnacht, Otilia Kimpel, Paul Schindler, Laura Schmidt-Pennington, Barbara Altieri, Felix Megerle, Harm Haak, James Pittaway, Ulrich Dischinger, Marcus Quinkler, Knut Mai, Matthias Kroiss, Bülent Polat, Martin Fassnacht

Abstract

Background: International guidelines emphasise the role of radiotherapy (RT) for the management of advanced adrenocortical carcinoma (ACC). However, the evidence for this recommendation is very low.

Methods: We retrospectively analysed all patients who received RT for advanced ACC in five European centres since 2000.

Primary endpoint: time to progression of the treated lesion (tTTP). Secondary endpoints: best objective response, progression-free survival (PFS), overall survival (OS), adverse events, and the establishment of predictive factors by Cox analyses.

Results: In total, 132 tumoural lesions of 80 patients were treated with conventional RT (cRT) of 50-60 Gy (n = 20) or 20-49 Gy (n = 69), stereotactic body RT of 35-50 Gy (SBRT) (n = 36), or brachytherapy of 12-25 Gy (BT) (n = 7). Best objective lesional response was complete (n = 6), partial (n = 52), stable disease (n = 60), progressive disease (n = 14). Median tTTP was 7.6 months (1.0-148.6). In comparison to cRT20-49Gy, tTTP was significantly longer for cRT50-60Gy (multivariate adjusted HR 0.10; 95% CI 0.03-0.33; p < 0.001) and SBRT (HR 0.31; 95% CI 0.12-0.80; p = 0.016), but not for BT (HR 0.66; 95% CI 0.22-1.99; p = 0.46). Toxicity was generally mild and moderate with three grade 3 events. No convincing predictive factors could be established.

Conclusions: This largest published study on RT in advanced ACC provides clear evidence that RT is effective in ACC.

Conflict of interest statement

MK received travel cost reimbursement, speaker honoraria, and research support from Ipsen Pharma. MF has served in an advisory board of HRA Pharma on the management of adrenocortical carcinoma. Remunerations paid to his university hospital. OK received speaker honoraria from HRA Pharma. PS, LSP, BA, MQ, JP, HH, UD, KM, BP declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2022. The Author(s).

Figures

Fig. 1. Time to local progress, time…
Fig. 1. Time to local progress, time to any progress and overall survival since RT in all patients with advanced ACC treated with RT.
Kaplan-Meier (right panel) and Cox regression (left panel) survival curves (A) for time to progress of the treated lesion (tTTP), (B) overall progression free survival (oPFS) and (C) overall survival (OS).

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Source: PubMed

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