Adjuvant Radiation Improves Recurrence-Free Survival and Overall Survival in Adrenocortical Carcinoma

Laila A. Gharzai, Michael D. Green, Kent A. Griffith, Tobias Else, Charles S. Mayo, Elizabeth Hesseltine, Daniel E. Spratt, Edgar Ben-Josef, Aaron Sabolch, Barbara S. Miller, Francis Worden, Thomas J. Giordano, Gary D. Hammer, Shruti Jolly*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Context: Adrenocortical carcinoma (ACC) is a rare malignancy with high rates of recurrence and poor prognosis. The role of radiotherapy (RT) in localized ACC has been controversial, and RT is not routinely offered. Objective: To evaluate the benefit of adjuvant RT on outcomes in ACC. Design: This is a retrospective propensity-matched analysis. Setting: All patients were seen through the University of Michigan's Endocrine Oncology program, and all those who underwent RT were treated at the University of Michigan. Participants: Of 424 patients with ACC, 78 were selected; 39 patients underwent adjuvant radiation. Intervention: Adjuvant RT to the tumor bed and adjacent lymph nodes. Main Outcomes Measures: Time to local failure, distant failure, or death. Results: Median follow-up time was 4.21 years (95% CI, 2.79 to 4.94). The median radiation dose was 55 Gy (range, 45 to 60). The 3-year overall survival estimate for patients improved from 48.6% for patients without RT (95% CI, 29.7 to 65.2) to 77.7% (95% CI, 56.3 to 89.5) with RT, with a hazard ratio (HR) of 3.59 (95% CI, 1.60 to 8.09; P = 0.002). RT improved local recurrence-free survival (RFS) from 34.2% (95% CI, 18.8 to 50.3) to 59.5% (95% CI, 39.0 to 75.0), with an HR of 2.67 (95% CI, 1.38 to 5.19; P = 0.0035). RT improved all RFS from 18.3% (95% CI, 6.7 to 34.3) to 46.7% (95% CI, 26.9 to 64.3), with an HR 2.59 (95% CI, 1.40 to 4.79; P = 0.0024). Conclusions: In the largest single institution study to date, adjuvant RT after gross resection of ACC improved local RFS, all RFS, and overall survival in this propensity-matched analysis. Adjuvant RT should be considered a part of multidisciplinary management for patients with ACC.

Original languageEnglish (US)
Article numberjcem_201900029
Pages (from-to)3743-3750
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume104
Issue number9
DOIs
StatePublished - Apr 11 2019
Externally publishedYes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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