Tiberio Guido Alberto Massimo, Ferrari Vittorio, Ballarini Zeno, Casole Giovanni, Laganà Marta, Gritti Michele, Arici Elisa, Grisanti Salvatore, Nascimbeni Riccardo, Sigala Sandra, Berruti Alfredo, Coniglio Arianna
Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy.
Clinical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and public Health, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, Italy.
Cancers (Basel). 2020 Apr 14;12(4):969. doi: 10.3390/cancers12040969.
This study explores the impact of Hypertermic Intra PEritoneal Chemotherapy (HIPEC) on adrenocortical carcinoma (ACC) management through a safety analysis completed by a preliminary evaluation of survival performances.
Retrospective chart review of 27 patients submitted to surgical treatment completed by HIPEC for primary (SP, 13 patients) or recurrent (SR, 14 patients, 17 treatments) ACC. Safety was evaluated by means of procedural morbidity and mortality. Survival performances included multiple end points: local/peritoneal disease-free survival (l/pDFS), overall progression-free survival (OPFS), and overall survival (OS).
In the SP group, mortality was nil and morbidity was 46% (major 23%). At a median follow-up of 25 months, the median value for all the different survival measures had not been reached. Mortality was also nil in the SR group. However, morbidity was 77% (major 18%). Median l/pDFS and OPFS were 12 ± 4 and 8 ± 2 months, respectively. At a median follow-up of 30 months, median OS had not been reached.
Surgery and HIPEC is an invasive procedure. Its employment in the surgery for primary setting deserves attention as it may affect oncologic outcomes positively. Its value in the management of recurrences seems less appreciable, albeit it may find its place in the multimodal management of a rare disease for which multiple therapeutic options do not yet exist.
本研究通过对生存表现的初步评估完成安全性分析，探讨热灌注腹腔内化疗（HIPEC）对肾上腺皮质癌（ACC）治疗的影响。
对27例行手术治疗并接受HIPEC的原发性（SP，13例患者）或复发性（SR，14例患者，17次治疗）ACC患者进行回顾性病历审查。通过手术并发症和死亡率评估安全性。生存表现包括多个终点：局部/腹膜无病生存期（l/pDFS）、总无进展生存期（OPFS）和总生存期（OS）。
在SP组中，死亡率为零，并发症发生率为46%（严重并发症为23%）。中位随访25个月时，所有不同生存指标的中位值均未达到。SR组的死亡率也为零。然而，并发症发生率为77%（严重并发症为18%）。中位l/pDFS和OPFS分别为12±4个月和8±2个月。中位随访30个月时，中位OS尚未达到。
手术联合HIPEC是一种侵入性操作。其在原发性手术中的应用值得关注，因为它可能对肿瘤学结局产生积极影响。其在复发治疗中的价值似乎不太明显，尽管它可能在尚无多种治疗选择的罕见疾病的多模式治疗中占有一席之地。
