title: Pulmonary resection for metastatic adrenocortical carcinoma: the National Cancer Institute experience.
abstract: BACKGROUND
  Adrenocortical carcinoma (ACC) is a rare neoplasm with a high propensity for locoregional recurrences and distant metastases for which there are no effective systemic therapies. This study was undertaken to determine outcomes of patients undergoing pulmonary metastasectomy for ACC.
  
  
  METHODS
  A single-institution retrospective review was performed of patients undergoing pulmonary metastasectomy for ACC from 1979 to 2010.
  
  
  RESULTS
  Twenty-six patients underwent 60 pulmonary metastasectomies. Fifteen patients (58%) underwent unilateral thoracotomy, 6 (23%) had staged thoracotomies, and 5 (19%) underwent median sternotomy as the initial thoracic procedure. Median number and size of lesions were 6 and 2 cm, respectively. Twenty-three patients (88%) were rendered free of disease in the lung, and 14 (54%) were rendered completely free of disease. Median overall and 5-year actuarial survivals from initial pulmonary metastasectomy were 40 months and 41%, respectively, with a median potential follow-up of 120 months. Median recurrence-free survival (RFS) and 5-year RFS for ipsilateral thoracic recurrences were 6 months, and 25%, respectively. The median RFS in the contralateral thorax was 5 months. Time to first recurrence after adrenalectomy and T stage of the primary tumor, but not adjuvant or neoadjuvant chemotherapy, were associated with increased overall survival after pulmonary metastasectomy.
  
  
  CONCLUSIONS
  This study represents the most comprehensive review of outcomes of patients undergoing pulmonary metastasectomy for ACC. Given the lack of effective systemic therapies, pulmonary metastasectomy may be beneficial in properly selected patients.
authors.affiliation: Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Kemp
authors.forename: R Taylor
authors.initials: RT
authors.lastname: Ripley
authors.forename: Aarti
authors.initials: A
authors.lastname: Mathur
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Dao M
authors.initials: DM
authors.lastname: Nguyen
authors.forename: Tito
authors.initials: T
authors.lastname: Fojo
authors.forename: David S
authors.initials: DS
authors.lastname: Schrump
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000473:pathology / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D054547:National Cancer Institute (U.S.); D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult