Oligometastatic adrenocortical carcinoma: the role of image-guided thermal ablation

Veltri, Andrea; Basile, Domenico; Calandri, Marco; Bertaggia, Chiara Eleonora; Volante, Marco; Porpiglia, Francesco; Calabrese, Anna; Puglisi, Soraya; Basile, Vittoria; Terzolo, Massimo

doi:10.1007/s00330-020-07019-w

Cited by 12 publications

(20 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overall, a combination of such techniques can be proposed and repeated over a patient’s treatment course ( Figure 4 ). These results stress the importance of early minimally invasive interventions to expect the best response with a low complication rate, as previously reported by Cazejuste et al [ 17 ] in 2010 and Velti et al [ 23 ]. Interestingly, DC, including stabilization, was found to be independently associated with longer TTC and OS, suggesting that this endpoint could be a surrogate marker in future studies [ 24 , 25 , 26 ].…”

Section: Discussionsupporting

confidence: 87%

Loco-Regional Therapies in Oligometastatic Adrenocortical Carcinoma

Roux

Boilève

Faron

et al. 2022

Cancers

View full text Add to dashboard Cite

Objective: The recommended first-line treatment for low-tumor-burden ACC (stage IVa ACC) not amenable to radical resection is mitotane in association with loco-regional treatments (LRs). The aim of this study was to determine the patient population that would benefit the most from LR. Materials and methods: This retrospective monocentric expert center chart review study was performed from 2008 to 2021 and included stage IVa patients (≤2 tumoral organs) treated with LR (either radiotherapy, surgery, or interventional radiology). The primary endpoint was disease control (DC). Correlations between DC, time to systemic chemotherapy (TTC), overall survival (OS), and tumor characteristics were analyzed using Kaplan–Meier survival analysis and Cox’s proportional hazards regression model for multivariate analysis. Results: Thirty-four women (57%) and 26 men with a median age of 48.1 years (IQR: 38.3–59.8) were included. One hundred and nine LRs were performed, with a median of 2 (IQR: 1–3) per patient. DC was achieved in 40 out of 60 patients (66.7%). Patients with DC had a significantly longer TTC (HR: 0.27, p < 0.001) and OS (HR: 0.22, p < 0.001). Patients with less than or equal to 5 metastases (HR: 6.15 (95% CI: 1.88–20.0), p = 0.002) or a maximum metastasis diameter below 3 cm had higher rates of DC (HR: 3.78 (95% CI: 1.09–13.14), p = 0.035). Conclusion: stage IVa ACC patients with ≤5 metastases or a maximum metastasis diameter below 3 cm had favorable responses to LR. We propose the name oligometastatic ACC for this subgroup of patients.

show abstract

Section: Discussionsupporting

confidence: 87%

Loco-Regional Therapies in Oligometastatic Adrenocortical Carcinoma

Roux

Boilève

Faron

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…A total of 66% of patients had disease progression and 50% died from cancer-related causes. Patients selected to receive tumor ablation had a five-year survival of 44%, which is higher than the 10–15% five-year survival typically quoted for stage IV disease [ 4 , 6 , 73 ]. This is likely due, at least in part, to selection bias.…”

Section: Current Treatment Approachesmentioning

confidence: 96%

Bridging the Scientific Gaps to Identify Effective Treatments in Adrenocortical Cancer

Michael

Nilubol

2022

Cancers

View full text Add to dashboard Cite

Adrenocortical cancer (ACC) typically presents in advanced stages of disease and has a dismal prognosis. One of the foremost reasons for this is the lack of available systemic therapies, with mitotane remaining the backbone of treatment since its discovery in the 1960s, despite underwhelming efficacy. Surgery remains the only potentially curative option, but about half of patients will recur post-operatively, often with metastatic disease. Other local treatment options have been attempted but are only used practically on a case-by-case basis. Over the past few decades there have been significant advances in understanding the molecular background of ACC, but this has not yet translated to better treatment options. Attempts at novel treatment strategies have not provided significant clinical benefit. This paper reviews our current treatment options and molecular understanding of ACC and the reasons why a successful treatment has remained elusive. Additionally, we discuss the knowledge gaps that need to be overcome to bring us closer to successful treatment and ways to bridge them.

show abstract

“…Its indications are additionally broadened to those unwilling or unfit for adrenalectomy due to co-morbidity [ 49 ]. It is in this regard that thermal therapy has been trialed amongst small cohorts as a (i) minimally invasive alternative to definitive management of benign adrenal adenomas [ 39 , 50 – 56 ], (ii) adrenal metastases in patients unsuitable for surgery and [ 3 , 10 , 48 ▪▪ , 57 – 59 ] (iii) for local management of metastatic adrenal cancers [ 60 ▪▪ , 61 ▪▪ , 62 , 63 ▪▪ ].…”

Section: Adrenal Tumours and The Role Of Thermal Ablationmentioning

confidence: 99%

“…The results of this study are encouraging, reporting radiological evidence of complete ablation in 97% of targeted lesions. Local progression was low and occurred in larger lesions, with an overall rate of 24% and a median local progression-free survival of 21 months [ 61 ▪▪ ]. Single case studies have demonstrated efficacy of this approach for spinal metastasis from ACC [ 60 ▪▪ ].…”

Section: Metastatic Cancers Of the Adrenalmentioning

confidence: 99%

“…Technical complications and structural damage are slightly higher for adrenal ablation when compared to ablation in other organs, due to the narrow window of approach [ 33 ]. These include pneumothorax [ 39 , 51 , 54 , 57 ], haemorrhage, vascular thrombosis and visceral perforation [ 11 , 39 , 54 , 58 , 61 ▪▪ , 62 , 63 ▪▪ ] (Table 2 ). Where patients with Cushing's syndrome have been treated, adrenocortical insufficiency, as expected has occurred [ 53 ].…”

Section: Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Thermal ablation in adrenal disorders: a discussion of the technology, the clinical evidence and the future

Donlon

Dennedy

2021

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

View full text Add to dashboard Cite

Purpose of review To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland. Recent findings Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma. Summary Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Appropriate technological design, treatment planning and choice of imaging modality are necessary to overcome technical challenges associated with this emerging therapeutic approach.

show abstract

Oligometastatic adrenocortical carcinoma: the role of image-guided thermal ablation

Cited by 12 publications

References 18 publications

Loco-Regional Therapies in Oligometastatic Adrenocortical Carcinoma

Loco-Regional Therapies in Oligometastatic Adrenocortical Carcinoma

Bridging the Scientific Gaps to Identify Effective Treatments in Adrenocortical Cancer

Thermal ablation in adrenal disorders: a discussion of the technology, the clinical evidence and the future

Contact Info

Product

Resources

About