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Cited by 101Adrenal and Paraganglionic TumorsRenal cell carcinoma treatmentSarcoma Diagnosis and Treatment

A retrospective cohort analysis of the efficacy of adjuvant radiotherapy after primary surgical resection in patients with adrenocortical carcinoma

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Habra, Mouhammed Amir, Ejaz, Shamim, Feng, Lei, Das, Prajnan, Deniz, Ferhat, Grubbs, Elizabeth G., Phan, Alexandria, Waguespack, Steven G. +5 more·2013·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2012-2367PMC PMC3537094
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Abstract

CONTEXT: Adrenocortical carcinoma (ACC) is a rare malignancy with high recurrence and mortality rates. The role of adjuvant radiation therapy (RT) to improve outcome remains unclear. OBJECTIVE: The aim of this study was to evaluate the impact of adjuvant RT on overall survival and recurrence rates of ACC patients. DESIGN: We conducted a retrospective cohort study of select ACC patients who were seen at The University of Texas MD Anderson Cancer Center (MDACC) between 1998 and 2011. All patients in this study underwent primary tumor resection and received adjuvant RT within 3 months of primary surgical resection prior to referral to the MDACC. We compared patients who had surgery and adjuvant RT with patients who had surgery alone. RESULTS: Baseline characteristics and adjuvant mitotane use were not significantly different between the adjuvant RT group (n = 16) and the non-RT group (n = 32). Local recurrence occurred in seven patients (43.8%) who received RT and 10 patients (31.3%) in the control group. At 5 yr, the estimated local recurrence-free rate (95% confidence interval) was 53% (32-87%) in the RT group and 67% (52-86%) in the non-RT group (P = 0.53). The distributions of time to distant recurrence and recurrence-free survival were not significantly different between the two groups. Using a multivariate Cox proportional hazards model for overall survival, the hazard ratio for RT use was 1.593 (95% confidence interval, 0.707-3.589; P = 0.26) after adjusting for stage and adjuvant mitotane therapy. CONCLUSIONS: ACC has high rates of recurrence. In our study, RT did not improve clinical outcomes in patients who received their initial care in the community. We believe there is a need for a collaborative, multicenter, prospective randomized trial to evaluate the role of adjuvant treatments (both mitotane and RT) to assess their impact on recurrence patterns and survival.

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  • Radiotherapy has been shown in several recent series to offer a significant improvement in disease control in both adjuvant and palliative settings, although such improvement has not been universally demonstrated.

    “Although traditionally considered ineffective for ACC (327–331), radiotherapy has been shown in several recent series to offer a significant improvement in disease control in both the adjuvant and palliative settings (247, 332–337), although such an improvement has not been universally demonstrated (338).”

    From Adrenocortical carcinoma (2014) · cites this paper as [338]

  • Patients in Habra et al were treated outside an academic center and might not have benefited from the multidisciplinary approach that such centers offer, particularly for rare cancers.

    “Although it is difficult to determine from retrospective series the reasons for such discordant outcomes, the patients reported on by Habra et al (338) were treated outside of an academic center and might not have benefited from the multidisciplinary approach that such centers offer, particularly for rare cancers.”

    From Adrenocortical carcinoma (2014) · cites this paper as [338]

  • In Habra et al, there were no significant differences in local control or survival between 16 patients treated with primary resection followed by adjuvant radiotherapy and 32 matched patients who received surgery alone.

    “There were no significant differences found in local control or survival between these 2 groups (338).”

    From Adrenocortical carcinoma (2014) · cites this paper as [338]

  • In Habra et al, local recurrence rate for patients receiving adjuvant radiotherapy after surgery was 44%, compared with 14% in Fassnacht et al and 20% in Sabolch et al.

    “More specifically, although Habra et al (338) found a local recurrence rate of 44% for such patients, Fassnacht et al (332) showed a 14% local failure rate and Sabolch et al (247) found a 20% rate.”

    From Adrenocortical carcinoma (2014) · cites this paper as [338]

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Authors
Habra, M. A., Ejaz, S., Feng, L., Das, P., Deniz, F., Grubbs, E. G., Phan, A., Waguespack, S. G., Ayala-Ramirez, M., Jimenez, C., Perrier, N. D., Lee, J. E., & Vassilopoulou-Sellin, R.
Affiliations
The University of Texas MD Anderson Cancer Center (US)
Corresponding author
Habra, Mouhammed Amir
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2013-01
Volume
98
Issue
1
Pages
192-197
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2012-2367
PMC
PMC3537094
OpenAlex
W2085986924
Cited by
101
References
29
Citations by year
2026: 2 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 6 · 2021: 6 · 2020: 7 · 2019: 7 · 2018: 7 · 2017: 10 · 2016: 5 · 2015: 15 · 2014: 11 · 2013: 5
FWCI
10.12
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (CA- 016672)
  • University of Texas MD Anderson Cancer Center ((CA016672), grant CA016672)
  • National Cancer Institute (CA 016672, P30CA016672)
  • National Center for Research Resources (UL1RR024148)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Sarcoma Diagnosis and Treatment
Keywords
adrenocortical carcinoma, adjuvant radiotherapy, surgical resection, local recurrence, overall survival, recurrence-free survival, community-based care
MeSH terms
Adrenal Cortex Neoplasms, Adrenalectomy, Adult, Aged, Female, Humans, Male, Middle Aged, Recurrence, Retrospective Studies, Cohort Studies, Survival Analysis, Case-Control Studies, Treatment Outcome, Adrenocortical Carcinoma, Disease-Free Survival, Radiotherapy, Adjuvant, Young Adult

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