Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan.
Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan.
Int J Radiat Oncol Biol Phys. 2015 Jun 1;92(2):252-9. doi: 10.1016/j.ijrobp.2015.01.007. Epub 2015 Mar 5.
Adrenocortical carcinoma (ACC) is a rare malignancy known for high rates of local recurrence, though the benefit of postoperative radiation therapy (RT) has not been established. In this study of grossly resected ACC, we compare local control of patients treated with surgery followed by adjuvant RT to a matched cohort treated with surgery alone.
We retrospectively identified patients with localized disease who underwent R0 or R1 resection followed by adjuvant RT. Only patients treated with RT at our institution were included. Matching to surgical controls was on the basis of stage, surgical margin status, tumor grade, and adjuvant mitotane.
From 1991 to 2011, 360 ACC patients were evaluated for ACC at the University of Michigan (Ann Arbor, MI). Twenty patients with localized disease received postoperative adjuvant RT. These were matched to 20 controls. There were no statistically significant differences between the groups with regard to stage, margins, grade, or mitotane. Median RT dose was 55 Gy (range, 45-60 Gy). Median follow-up was 34 months. Local recurrence occurred in 1 patient treated with RT, compared with 12 patients not treated with RT (P=.0005; hazard ratio [HR] 12.59; 95% confidence interval [CI] 1.62-97.88). However, recurrence-free survival was no different between the groups (P=.17; HR 1.52; 95% CI 0.67-3.45). Overall survival was also not significantly different (P=.13; HR 1.97; 95% CI 0.57-6.77), with 4 deaths in the RT group compared with 9 in the control group.
Postoperative RT significantly improved local control compared with the use of surgery alone in this case-matched cohort analysis of grossly resected ACC patients. Although this retrospective series represents the largest study to date on adjuvant RT for ACC, its findings need to be prospectively confirmed.
肾上腺皮质癌（ACC）是一种罕见的恶性肿瘤，局部复发率很高，尽管术后放射治疗（RT）的益处尚未确定。在这项研究中，我们比较了接受手术和辅助 RT 治疗的患者与仅接受手术治疗的患者的局部控制情况。
我们回顾性地确定了接受 R0 或 R1 切除术后接受辅助 RT 的局限性疾病患者。仅包括在我们机构接受 RT 治疗的患者。手术对照的匹配是基于分期、手术切缘状态、肿瘤分级和辅助米托坦。
1991 年至 2011 年，密歇根大学（安阿伯，MI）对 360 名 ACC 患者进行了 ACC 评估。20 名局限性疾病患者接受了术后辅助 RT。这些患者与 20 名对照患者相匹配。两组在分期、切缘、分级或米托坦方面无统计学差异。中位 RT 剂量为 55 Gy（范围，45-60 Gy）。中位随访时间为 34 个月。接受 RT 治疗的患者中有 1 例局部复发，而未接受 RT 治疗的患者中有 12 例（P=.0005；危险比[HR] 12.59；95%置信区间[CI] 1.62-97.88）。然而，两组之间的无复发生存率无差异（P=.17；HR 1.52；95% CI 0.67-3.45）。总生存率也无显著差异（P=.13；HR 1.97；95% CI 0.57-6.77），RT 组有 4 例死亡，对照组有 9 例死亡。
在这项大体切除的 ACC 患者病例匹配队列分析中，与单独手术相比，术后 RT 显著改善了局部控制。尽管这项回顾性研究是迄今为止关于 ACC 辅助 RT 的最大研究，但仍需要前瞻性证实。
