title: Liver resection and ablation for metastatic adrenocortical carcinoma.
abstract: BACKGROUND
  Adrenocortical carcinoma (ACC) is a rare disease without effective chemotherapy treated most appropriately with resection. The aim of this study was to evaluate our experience with liver resection for metastatic ACC.
  
  
  METHODS
  This study is a retrospective review of patients who underwent liver resection or radiofrequency ablation (RFA) for ACC from 1979 to 2009.
  
  
  RESULTS
  A total of 27 patients were identified. Of the 27, 19 underwent liver resection. Of the 19, 10 had a single liver lesion, and 18 of 19 were rendered free of disease in the liver, although only 11 of 19 were rendered completely free of disease because of extrahepatic disease (EHD). Of the 19, 13 had synchronous EHD. Also, 6 of 17 remained disease free in the liver at a median follow-up of 6.2 years (status of 2 of 19 was unknown). Of the 27 patients, 8 underwent RFA, 7 of 8 became free of disease in the liver, and 5 of 7 had EHD. No patients responded to prior chemotherapy. Median overall survival and survival of patients who underwent liver resection or RFA were both 1.9 years (0.2-12 + years); 5-year actuarial survivals were 29% and 29%, respectively. Disease-free interval (DFI) greater than 9 months from primary resection was associated with longer survival (median 4.1 vs 0.9 years; P = .013).
  
  
  CONCLUSIONS
  This study is a tertiary institution series of liver resection and RFA for ACC. Given the lack of effective systemic treatment options and the safety of resection and ablation, liver resection or RFA may be considered in selected patients with ACC metastatic to the liver especially with a long DFI.
authors.affiliation: National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. Taylor.Ripley@gmail.com
authors.forename: R Taylor
authors.initials: RT
authors.lastname: Ripley
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Kemp
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Davis
authors.forename: Russell C
authors.initials: RC
authors.lastname: Langan
authors.forename: Richard E
authors.initials: RE
authors.lastname: Royal
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.forename: Udai S
authors.initials: US
authors.lastname: Kammula
authors.forename: Tito
authors.initials: T
authors.lastname: Fojo
authors.forename: Itzhak
authors.initials: I
authors.lastname: Avital
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000473:pathology / Q000628:therapy*; D018268:Adrenocortical Carcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult