Yttrium-90 microsphere selective internal radiation therapy for liver metastases following systemic chemotherapy and surgical resection for metastatic adrenocortical carcinoma

Abstract

Adrenocortical carcinoma (ACC) is a rare malignancy with generally poor outcomes and limited treatment options. While surgical resection can be curative for early local disease, most patients present with advanced ACC owing to nonspecific symptoms. For those patients, treatment options include systemic chemotherapy and locoregional therapies including radiofrequency ablation and transarterial chemoembolization. We present the first reported case of utilizing yttrium-90 microsphere selective internal radiation therapy (SIRT) in combination with first line EDP-M (Etoposide, Doxorubicin, Cisplatin, Mitotane) chemotherapy and debulking surgical primary tumor resection for treatment of metastatic ACC. Stable complete radiologic response has been maintained after twelve months with resolution of clinical symptoms. These findings prompt the need for further consideration and studies to elucidate the role of SIRT in combination with systemic and surgical treatment for metastatic ACC.

Yttrium-90 Radioembolization of Metastatic Adrenocortical Carcinoma to the Liver following Systemic Chemotherapy and Surgical Resection of the Primary Lesion

“…After undergoing bilobar Y-90 treatment, the patient demonstrated a marked clinical and radiographic response. The performance status improved dramatically from ECOG 3 to ECOG 0 [4]. This case report, along with the similar previously reported case, demonstrates a key role for Y-90 therapy in targeting ACC liver metastatic disease.…”

“…The use of Y-90 for metastatic ACC liver disease as in this case is currently off-label. We came across only one such documented case report with similar positive results in the management of metastatic ACC to the liver refractory to chemotherapy [4]. In this case report, we described a 52-year-old man with stage 4 ACC and extensive liver metastatic disease.…”

“…The use of Y-90 to treat adrenal metastases to the liver is off-label and has only been documented once. Within that study, metastatic ACC was treated by combining locoregional Y-90 therapy for bilobar liver disease with first-line etoposide, doxorubicin, and cisplatin plus mitotane (EDP-M) chemotherapy and debulking surgery [4]. The treatment allowed the patient to remain recurrence free for 12 months.…”

Yttrium-90 Radioembolization of Isolated Hepatic Adrenocortical Carcinoma Metastases With Negative Surgical Pathology

“…Options for systemic treatment of advanced ACC have been with an EDP-M schedule (Etoposide, Doxorubicin, Cisplatin, plus Mitotane) or a M-S schedule (Mitotane plus Streptozotocin) 8 . These regimens have comparable overall survival (14.8 vs 12 months), but EDP-M has been favored due to improved response rates and progression-free survival (5 vs 2.1 months) 2,9 . Noninvasive radiation therapy has demonstrated no survival bene t and no reduction in the risk of metastasis 10 .…”

“…Treatment of local disease involves surgical resection, but this is infrequently curative, with an 80% recurrence rate even after complete resection 1,2 . Radiofrequency ablation has demonstrated some success for primary unresectable ACC < 5 cm 1,5,6 .…”