Kimpel Otilia, Altieri Barbara, Laganà Marta, Vogl Thomas J, Adwan Hamzah, Dusek Tina, Basile Vittoria, Pittaway James, Dischinger Ulrich, Quinkler Marcus, Kroiss Matthias, Puglisi Soraya, Cosentini Deborah, Kickuth Ralph, Kastelan Darko, Fassnacht Martin
Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, 97070 Würzburg, Germany.
Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25123 Brescia, Italy.
Cancers (Basel). 2024 Feb 7;16(4):706. doi: 10.3390/cancers16040706.
International guidelines recommend local therapies (LTs) such as local thermal ablation (LTA; radiofrequency, microwave, cryoablation), transarterial (chemo)embolisation (TA(C)E), and transarterial radioembolisation (TARE) as therapeutic options for advanced adrenocortical carcinoma (ACC). However, the evidence for these recommendations is scarce. We retrospectively analysed patients receiving LTs for advanced ACC. Time to progression of the treated lesion (tTTP) was the primary endpoint. The secondary endpoints were best objective response, overall progression-free survival, overall survival, adverse events, and the establishment of predictive factors by multivariate Cox analyses. A total of 132 tumoural lesions in 66 patients were treated with LTA (n = 84), TA(C)E (n = 40), and TARE (n = 8). Complete response was achieved in 27 lesions (20.5%; all of them achieved by LTA), partial response in 27 (20.5%), and stable disease in 38 (28.8%). For the LTA group, the median tTTP was not reached, whereas it was reached 8.3 months after TA(C)E and 8.2 months after TARE ( < 0.001). The median time interval from primary diagnosis to LT was >47 months. Fewer than four prior therapies and mitotane plasma levels of >14 mg/L positively influenced the tTTP. In summary, this is one of the largest studies on LTs in advanced ACC, and it demonstrates a very high local disease control rate. Thus, it clearly supports the guideline recommendations for LTs in these patients.
国际指南推荐局部热消融（LTA；射频、微波、冷冻消融）、经动脉（化疗）栓塞（TA（C）E）和经动脉放射性栓塞（TARE）等局部治疗（LTs）作为晚期肾上腺皮质癌（ACC）的治疗选择。然而，这些推荐的证据并不充分。我们回顾性分析了接受LTs治疗的晚期ACC患者。治疗病灶的进展时间（tTTP）是主要终点。次要终点包括最佳客观缓解、总无进展生存期、总生存期、不良事件以及通过多变量Cox分析确定预测因素。66例患者共132个肿瘤病灶接受了LTA（n = 84）、TA（C）E（n = 40）和TARE（n = 8）治疗。27个病灶（20.5%；均通过LTA实现）达到完全缓解，27个（20.5%）达到部分缓解，38个（28.8%）病情稳定。对于LTA组，未达到中位tTTP，而TA（C）E后为8.3个月，TARE后为8.2个月（<0.001）。从初次诊断到接受LT的中位时间间隔>47个月。既往治疗少于4次且米托坦血浆水平>14 mg/L对tTTP有积极影响。总之，这是关于晚期ACC中LTs的最大规模研究之一，并且显示出非常高的局部疾病控制率。因此，它明确支持了这些患者LTs的指南推荐。
