Response to mitotane predicts outcome in patients with recurrent adrenal cortical carcinoma.
BACKGROUND
Adrenal cortical carcinoma (ACC) is a rare disease in which recurrence after surgery is common. Mitotane is the primary systemic treatment for recurrent ACC; data are limited regarding the impact of mitotane on recurrent ACC.


METHODS
We reviewed the records of all patients who underwent surgery for ACC evaluated at our institution from 1991 to 2006.


RESULTS
The median disease-free survival for all 186 patients was 12 months and the median overall survival (OS) was 37 months. Higher stage at presentation (P = .002) and tumor cortisol production (P = .007) were associated with a worse OS. Mitotane was given to 67 evaluable patients with recurrent ACC. A response to mitotane was observed in 13 (19%) of the 67 patients. For patients with stable or responding disease to mitotane, the median OS from date of recurrence was 18 months, compared with 9 months (P = .01) for those who progressed.


CONCLUSIONS
Patients with recurrent ACC who have stable or responding disease to mitotane have a more favorable prognosis than those who progress. Mitotane should be considered in most patients with recurrent ACC, including as preoperative therapy for those with recurrent disease considered for surgical resection.
Gonzalez
Ricardo J
RJ
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
Tamm
Eric P
EP
Ng
Chaan
C
Phan
Alexandria T
AT
Vassilopoulou-Sellin
Rena
R
Perrier
Nancy D
ND
Evans
Douglas B
DB
Lee
Jeffrey E
JE
D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008939:Mitotane / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis
D018931:Antineoplastic Agents, Hormonal; D008939:Mitotane