Thermal ablation of metastatic adrenocortical carcinoma: long-term results

Authors

• GM Varano
• L Jiang
• VP Krishnasamy
• N Jain
• H Amalou
• M Edgerly
• M Velarde
• N Abi Jaoudeh
• AM Venkatesan
• EB Levy
• A Fojo
• BJ Wood

Abstract

Adrenocortical carcinoma (ACC) is a rare but aggressive malignancy with few effective therapeutic options. Only surgery has been shown to improve outcomes. Thermal ablation has emerged as a minimally invasive option in the treatment of metastatic ACC, particularly in patients who are poor surgical candidates. It is possible, although unproven, that aggressive local control with ablation may also improve outcomes. This study aims to characterize long-term clinical outcomes of ablation for metastatic ACC. A retrospective review was performed on patients who underwent ablation for metastatic ACC at NIH from February 1999 to September 2014. Radiographic and clinical data were evaluated longitudinally. Kaplan-Meier survival analysis was employed without controlling for additional therapies, which were highly variable among patients. Thirty-one patients (14 men and 17 women, ages 24 to 73) with a total of 70 metastatic ACC lesions were treated with ablation. Mean follow-up was 35 months (range, 2 to 184 months). Eight lesions were ablated only for pain palliation and were excluded from analysis. Technical success, defined as the absence of enhancement in the tumor bed on initial follow up imaging, was achieved for 53 of 62 lesions (85%) treated for local control, including 36 of 43 liver lesions (84%). Site-specific progression after successful ablation was 5.2% at 5 years. Median 5-year survival after diagnosis was 50.3%. Median overall survival after diagnosis and progression-free survival were 71 months and 5 months, respectively. In appropriately selected patients, thermal ablation may be useful for local control in multidisciplinary approaches to metastatic ACC management.

Scientific Focus Area: Cancer Biology

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