title: Peritoneal metastases from adrenal cortical carcinoma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
abstract: OBJECTIVE
  Adrenal cortical carcinoma is a rare cancer that often presents in an advanced stage. Not only systemic metastases but also local recurrence and peritoneal metastases prevent long-term survival in these patients.
  
  
  METHODS
  A profoundly symptomatic patient with extensive peritoneal metastases and local recurrence was treated using cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with melphalan as the chemotherapy agent.
  
  
  RESULTS
  Relative sparing of the small bowel within the abdomen and pelvis allowed a visible complete resection of all cancer. The HIPEC with melphalan was used to control microscopic residual disease. Similar surgical technology used in this patient could be used to prevent local recurrence and peritoneal metastases in patients at the time of resection of the primary adrenal cortical carcinoma.
  
  
  CONCLUSIONS
  Rare diseases may have peritoneal metastases as a component of disease progression and profit from treatment with CRS plus HIPEC. The clinical features suggesting a favorable outcome from this combined treatment are relative sparing of small bowel and its mesentery, absence of disease outside the abdomen, low-grade disease, or limited extent of high-grade disease.
authors.affiliation: Program in Peritoneal Surface Oncology, Center for Gastrointestinal Malignancy, MedStar Washington Hospital Center, Washington, DC - USA.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Sugarbaker
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D018268:Adrenocortical Carcinoma / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008558:Melphalan / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan