title: Adjuvant helical IMRT by tomotherapy for bulky adrenocortical carcinoma operated with positive margins: a case report.
abstract: BACKGROUND
  Adrenocortical carcinoma (ACC) is a rare tumor in the adult. The main therapy is surgery but in some cases radiotherapy may be needed to control the disease locally.
  
  
  METHODS
  A patient with a surgically removed bulky ACC and pathologic finding of a positive margin was treated at our center by adjuvant mitotane and radiotherapy using an intensity-modulated radiation therapy (IMRT)/image-guided radiotherapy (IGRT) technique by tomotherapy. Dose prescriptions were 63 Gy on the surgical bed and 50.4 Gy on the lymphatic drainage in 28 sessions. Patient compliance was good with no evidence of acute or late toxicities.
  
  
  RESULTS
  Thirty months after radiotherapy, the patient is alive without evidence of disease checked by 18F-fluorodeoxyglucose positron emission tomography/computed tomography and without any complication.
  
  
  CONCLUSIONS
  In patients with adverse prognostic features, the delivery of adequate adjuvant radiotherapy doses with IMRT and daily IGRT is feasible and safe and could result in an improved outcome for patients with ACC.
authors.affiliation: Radiotherapy Division of the FPO-IRCCS Cancer Center, Candiolo (Turin) - Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Delmastro
authors.affiliation: Radiotherapy Division of the FPO-IRCCS Cancer Center, Candiolo (Turin) - Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Garibaldi
authors.affiliation: Neuroscience Department, Human Physiology Section, University of Turin, Turin - Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Gabriele
authors.affiliation: Medical Physics Division of the FPO-IRCCS Cancer Center, Candiolo (Turin) - Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Bresciani
authors.affiliation: Radiotherapy Division of the FPO-IRCCS Cancer Center, Candiolo (Turin) - Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Cattari
authors.affiliation: Medical Physics Division of the FPO-IRCCS Cancer Center, Candiolo (Turin) - Italy.
authors.forename: Amalia Di
authors.initials: AD
authors.lastname: Dia
authors.affiliation: Pathology Division of the San Giovanni Bosco Hospital, Turin - Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Manini
authors.affiliation: Urology Division of the San Giovanni Bosco Hospital, Turin - Italy.
authors.forename: Devis
authors.initials: D
authors.lastname: Collura
authors.affiliation: Radiotherapy Unit, S. Luigi Hospital, Orbassano, University of Turin, Turin - Italy.
authors.forename: Maria Grazia Ruo
authors.initials: MG
authors.lastname: Redda
authors.affiliation: Radiotherapy Division of the FPO-IRCCS Cancer Center, Candiolo (Turin) - Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gabriele
mesh_terms: D018268:Adrenocortical Carcinoma / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D003131:Combined Modality Therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D000072662:Margins of Excision; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome