title: Adjuvant mitotane treatment for adrenocortical carcinoma.
abstract: BACKGROUND
  Adrenocortical carcinoma is a rare neoplasm characterized by a high risk of recurrence after radical resection. Whether the use of mitotane is beneficial as an adjuvant treatment has been controversial. Our aim was to evaluate the efficacy of adjuvant mitotane in prolonging recurrence-free survival.
  
  
  METHODS
  We performed a retrospective analysis involving 177 patients with adrenocortical cancer who had undergone radical surgery at 8 centers in Italy and 47 centers in Germany between 1985 and 2005. Adjuvant mitotane was administered to 47 Italian patients after radical surgery (mitotane group), whereas 55 Italian patients and 75 German patients (control groups 1 and 2, respectively) did not receive adjuvant treatment after surgery.
  
  
  RESULTS
  Baseline features in the mitotane group and the control group from Italy were similar; the German patients were significantly older (P=0.03) and had more stage I or II adrenocortical carcinomas (P=0.02) than did patients in the mitotane group. Recurrence-free survival was significantly prolonged in the mitotane group, as compared with the two control groups (median recurrence-free survival, 42 months, as compared with 10 months in control group 1 and 25 months in control group 2). Hazard ratios for recurrence were 2.91 (95% confidence interval [CI], 1.77 to 4.78; P<0.001) and 1.97 (95% CI, 1.21 to 3.20; P=0.005), respectively. Multivariate analysis indicated that mitotane treatment had a significant advantage for recurrence-free survival. Adverse events associated with mitotane were mainly of grade 1 or 2, but temporary dose reduction was needed in 13% of patients.
  
  
  CONCLUSIONS
  Adjuvant mitotane may prolong recurrence-free survival in patients with radically resected adrenocortical carcinoma.
authors.affiliation: Università di Torino, Turin, Italy. terzolo@usa.net
authors.forename: Massimo
authors.initials: M
authors.lastname: Terzolo
authors.forename: Alberto
authors.initials: A
authors.lastname: Angeli
authors.forename: Martin
authors.initials: M
authors.lastname: Fassnacht
authors.forename: Fulvia
authors.initials: F
authors.lastname: Daffara
authors.forename: Libuse
authors.initials: L
authors.lastname: Tauchmanova
authors.forename: Pier Antonio
authors.initials: PA
authors.lastname: Conton
authors.forename: Ruth
authors.initials: R
authors.lastname: Rossetto
authors.forename: Lisa
authors.initials: L
authors.lastname: Buci
authors.forename: Paola
authors.initials: P
authors.lastname: Sperone
authors.forename: Erika
authors.initials: E
authors.lastname: Grossrubatscher
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Reimondo
authors.forename: Enrico
authors.initials: E
authors.lastname: Bollito
authors.forename: Mauro
authors.initials: M
authors.lastname: Papotti
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Saeger
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hahner
authors.forename: Ann-Cathrin
authors.initials: AC
authors.lastname: Koschker
authors.forename: Emanuela
authors.initials: E
authors.lastname: Arvat
authors.forename: Bruno
authors.initials: B
authors.lastname: Ambrosi
authors.forename: Paola
authors.initials: P
authors.lastname: Loli
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lombardi
authors.forename: Massimo
authors.initials: M
authors.lastname: Mannelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Bruzzi
authors.forename: Franco
authors.initials: F
authors.lastname: Mantero
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
authors.forename: Luigi
authors.initials: L
authors.lastname: Dogliotti
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berruti
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D018268:Adrenocortical Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008939:Mitotane / Q000009:adverse effects / Q000627:therapeutic use*; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D018931:Antineoplastic Agents, Hormonal; D008939:Mitotane