Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2024 Jan 8;14:1308231. doi: 10.3389/fendo.2023.1308231. eCollection 2023.
Adrenocortical carcinoma (ACC) is rare and have high rates of recurrence and mortality. The role of adjuvant radiation therapy (RT) in localized ACC was controversial.
We conducted a retrospective study in our center between 2015 and 2021 to evaluate the efficacy and safety of adjuvant RT in localized ACC. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to estimate the independent risk factors. Adverse events associated with RT were documented according to the toxicity criteria of the radiation therapy oncology group (RTOG) and the common terminology criteria for adverse events (CTCAE v5.0).
Of 105 patients with localized ACC, 46 (43.8%) received adjuvant RT after surgery. The median radiation dose was 45.0Gy (range:30.0-50.4) and median follow up time was 36.5 (IQR: 19.7-51.8) months. In comparison to the no adjuvant RT group, patients with adjuvant RT had better 3-year OS (87.9% vs 79.5%, P=0.039), especially for patients with ENSAT I/II stage (P=0.004). Adjuvant RT also improved the median DFS time from 16.5months (95%CI, 12.0-20.9) to 34.6months (95%CI, 16.1-53.0). Toxicity of RT was generally mild and moderate with six grade 3 events.
Postoperative adjuvant RT significantly improved OS and DFS compared with the use of surgery alone in resected ACC patients. Although this retrospective study on RT in localized ACC indicates that RT is effective in ACC, its findings need to be prospectively confirmed.
肾上腺皮质癌（ACC）较为罕见，具有较高的复发率和死亡率。辅助放疗（RT）在局限性 ACC 中的作用存在争议。
我们对 2015 年至 2021 年期间在我院进行的一项回顾性研究进行分析，以评估辅助 RT 在局限性 ACC 中的疗效和安全性。采用 Kaplan-Meier 法估计总生存期（OS）和无病生存期（DFS）。采用 Cox 比例风险回归模型估计独立危险因素。根据放射肿瘤学组（RTOG）和常见不良事件术语标准（CTCAE v5.0）记录与 RT 相关的不良反应。
在 105 例局限性 ACC 患者中，46 例（43.8%）在手术后接受了辅助 RT。中位放疗剂量为 45.0Gy（范围：30.0-50.4），中位随访时间为 36.5（IQR：19.7-51.8）个月。与未行辅助 RT 组相比，行辅助 RT 患者的 3 年 OS 更好（87.9%比 79.5%，P=0.039），尤其是 ENSAT I/II 期患者（P=0.004）。辅助 RT 还将中位 DFS 时间从 16.5 个月（95%CI，12.0-20.9）延长至 34.6 个月（95%CI，16.1-53.0）。RT 的毒性通常较轻，中度毒性有 6 例。
与单纯手术相比，术后辅助 RT 可显著提高切除后的 ACC 患者的 OS 和 DFS。尽管这项关于局限性 ACC 中 RT 的回顾性研究表明 RT 对 ACC 有效，但仍需前瞻性证实。
