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A Phase II Trial of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Adrenocortical Carcinoma. | LitMetric

AI Article Synopsis

  • Recurrent adrenocortical carcinoma (ACC) is a challenging disease with limited effective treatments, and this study investigates the potential benefits of combining cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC).
  • A clinical trial involved 63 patients, with 11 eligible for the study; 9 received the treatment, revealing no serious perioperative mortality and manageable complications.
  • Results showed an average intraperitoneal progression-free survival of 19 months, but many experienced recurrence, suggesting while the approach is feasible, further options are needed for better outcomes.

Article Abstract

Background: Recurrent adrenocortical carcinoma (ACC) is an aggressive disease with few options offering durable survival benefit. Despite metastasectomy, recurrence is common. Cytoreduction and intraperitoneal chemotherapy have offered improved survival in other advanced cancers. We sought to evaluate the use of cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of recurrent intraperitoneal ACC.

Methods: A phase II, single institution clinical trial was approved for patients with radiographic evidence of resectable ACC limited to the peritoneum. Patients underwent treatment if optimal cytoreduction was deemed possible at exploratory laparotomy. Primary outcome was intraperitoneal progression-free survival. Secondary outcomes were treatment-related morbidities and overall survival.

Results: Sixty-three patients were evaluated, of whom 11 met eligibility criteria. Nine patients underwent cytoreduction and HIPEC, including one patient who recurred and was re-treated (n = 10 treatments). One patient could not be optimally cytoreduced for HIPEC and therefore did not receive intraperitoneal chemotherapy. There was no perioperative mortality; perioperative comorbidities were limited to Clavien-Dindo grade 2 or 3 and included hematologic, infectious, and neurologic complications. Seven patients experienced disease recurrence and two patients died of disease during follow-up (median 24 mo). Intraperitoneal progression-free survival was 19 mo, and median overall survival has not yet been reached.

Conclusions: Cytoreduction and HIPEC can be performed safely in selected patients. Patients with recurrent ACC confined to the peritoneal cavity can be considered for regional therapy in experienced hands. However, disease recurrence is common, and other treatment options should be explored.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054912PMC
http://dx.doi.org/10.1016/j.jss.2018.06.012DOI Listing

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