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

Abstract

BackgroundAdrenocortical carcinoma (ACC) is an uncommon malignancy with an estimated 15,400 new cases annually across the globe. The prognosis is generally poor as the disease is often already advanced at initial diagnosis due to non-specific symptoms. Even for local disease, recurrence after surgical resection is high. Treatment choices for advanced disease include Mitotane, chemotherapy, ablation, chemoembolization, radioembolization, and external beam radiotherapy, with varying degrees of efficacy. To the best of our knowledge, there have only been two prior case studies of complete clinical and radiological response of stage 4 disease at 1 year and 2 years after [90Y]yttrium (Y-90) microsphere selective internal radiation therapy (SIRT) of isolated hepatic metastases post-surgery and chemotherapy.Case presentationWe present a case of stage 1 ACC at time of diagnosis with subsequent development of hepatic metastases 6 years later, treated with Y-90 SIRT along with surgical resection and chemotherapy, with a surgically-proven negative pathology after partial hepatectomy 7 months after Y-90 SIRT. Bland embolization was used to successfully redistribute flow from a feeding right inferior phrenic artery to the right hepatic artery for effective selective radioembolization. Due to long term use of hydrocortisone causing adrenal insufficiency, the patient developed a post SIRT adrenal crisis, which was successfully controlled with steroids, highlighting the need for pre SIRT stress dose steroids. ConclusionsThis case continues to add to the literature supporting Y-90 radioembolization as an effective treatment for isolated hepatic ACC metastases. Our case is the first to demonstrate surgically proven negative pathology after radioembolization. Further prospective study is warranted to better establish efficacy as well as safety of SIRT for ACC liver metastases.