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

et al. 2020

Preprint

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.

Section: Resultsmentioning

confidence: 99%

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

Lu¹,

et al. 2020

Preprint

“…The metastatic disease burden in our case was limited to the right hepatic lobe, and only one radioembolization procedure was necessary. Two prior cases demonstrated 12-month and 24-month radiologic and clinical response, respectively, and had bilobar disease thus requiring two separate 90 Y radioembolizations [ 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Adrenocortical carcinoma (ACC) affects an estimated 0.5 – 2 new cases per million people annually, with a median survival of less than one year for stage 4 disease [ 1 – 3 ]. Overall, the median 5-year survival is 16–44% [ 4 ]. The prognosis is considerably better for stage 1 with a 5-year survival of 60%, compared to 0% for stage 4 [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Transcatheter arterial chemoembolization (TACE) has been reported with favorable outcomes for isolated hepatic metastatic lesions < 3 cm [ 1 , 7 ]. To date, there has only been two case reports demonstrating efficacy of 90 Y radioembolization for hepatic ACC metastases by follow-up imaging [ 2 , 4 ]. Three additional cases of 90 Y SIRT from a single institution demonstrated prolonged overall survival in patients with hepatic ACC metastases when analyzed in combination with 2 cases of liver-directed therapy treated with TACE [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Yttrium-90 radioembolization of isolated hepatic adrenocortical carcinoma metastases with negative surgical pathology

et al. 2021

EJNMMI Res

Background Adrenocortical 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 yttrium-90 (90Y) microsphere selective internal radiation therapy (SIRT) of isolated hepatic metastases post-surgery and chemotherapy. Case presentation We present a case of a 58-year-old man with metastatic ACC who was treated with 90Y resin microsphere (SIR-spheres) for local control of liver metastases leading to a surgically proven negative pathology after partial hepatectomy 7 months after SIRT. The patient was initially diagnosed with stage 1 ACC that progressed 6 years later to stage 4 disease with new liver metastases that were deemed unresectable at an outside institution. After review of the case at multidisciplinary tumor board, he was referred for liver directed therapy for local tumor control. Angiographic workup demonstrated partial extrahepatic supply to the tumors from the right inferior phrenic artery, which was successfully embolized on the day of SIRT for flow redistribution. As the patient was being treated with mitotane that suppresses steroid production, he developed post-SIRT adrenal crisis, which was successfully controlled with steroids, highlighting the need for pre SIRT stress dose steroids. Conclusions This case continues to add to the literature supporting 90Y 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.

“…Transcatheter arterial chemoembolization (TACE) has been reported with favorable outcomes for isolated hepatic metastatic lesions < 3 cm 1,7 . To date, there has only been two case reports demonstrating e cacy of 90 Y radioembolization for hepatic ACC metastases by follow up imaging 2,4 . Three additional cases of 90 Y SIRT from a single institution demonstrated prolonged overall survival in patients with hepatic ACC metastases when analyzed in combination with 2 cases of liver-directed therapy treated with TACE 8 .…”

Section: Introductionmentioning

confidence: 99%

Yttrium-90 radioembolization of isolated hepatic adrenocortical carcinoma metastases with negative surgical pathology

Lu¹,

et al. 2021

Preprint

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 Yttrium-90 (90Y) microsphere selective internal radiation therapy (SIRT) of isolated hepatic metastases post-surgery and chemotherapy.Case presentationWe present a case of a 58-year-old man with metastatic ACC who was treated with 90Y resin microsphere (SIR-spheres) for local control of liver metastases leading to a surgically-proven negative pathology after partial hepatectomy 7 months after SIRT. The patient was initially diagnosed with stage 1 ACC that progressed 6 years later to stage 4 disease with new liver metastases that were deemed unresectable at an outside institution. After review of the case at multidisciplinary tumor board, he was referred for liver directed therapy for local tumor control. Angiographic work up demonstrated partial extrahepatic supply to the tumors from the right inferior phrenic artery, which was successfully embolized on the day of SIRT for flow redistribution. As the patient was being treated with mitotane that suppresses steroid production, he developed 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 90Y 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.