Baxendale-Smith Leo, El-Shakankery Karim, Gordon-Smith James, Wall Lucy
Department of Medical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road, South, Edinburgh, United Kingdom.
Department of Interventional Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Endocr Oncol. 2024 Jul 8;4(1):e230041. doi: 10.1530/EO-23-0041. eCollection 2024 Jan 1.
Selective internal radiation therapy (SIRT) is a novel intervention for both primary and metastatic malignant liver lesions. Adrenocortical carcinoma (ACC) is rare with limited treatment options; evidence for SIRT in ACC liver metastases consists of case reports only. Selective internal radiation therapy (SIRT) was employed to treat recurrent liver metastases in a 49-year-old gentleman with ACC, who previously underwent a left-sided hepatectomy. The patient opted for SIRT after reviewing the literature regarding mitotane chemotherapy and its toxicities. Selective internal radiation therapy (SIRT) provided several months of progression-free survival (PFS), with no toxicity and an excellent radiological response. The patient re-presented 12 years after the initial diagnosis with skeletal metastases and sadly died in September 2022. Substantial unmet need exists for effective treatments in ACC, with 75% of patients presenting with incurable disease. Developing widespread disease, SIRT offered 2 years' PFS in our patient; this was well tolerated with minimal residual liver impairment. Its use in ACC liver-limited disease warrants investigation.
Adrenocortical carcinoma (ACC) is a rare and aggressive tumour with limited treatments. Once metastatic disease develops, existing standard-of-care treatments offer a dismal overall survival, alongside marked toxicities. Selective internal radiation therapy (SIRT) may represent a new intervention in the treatment paradigm for liver-limited, metastatic ACC. Here, we present the case of a patient treated with multiple rounds of SIRT for relapsed, liver-limited ACC, prolonging survival by several years. Recurrent SIRT led to maintained liver function and no toxicities. Little evidence outlines its use in ACC but further study is certainly warranted to ascertain the value of SIRT, considering the limited treatment landscape that currently exists.
选择性体内放射治疗（SIRT）是一种针对原发性和转移性恶性肝脏病变的新型干预措施。肾上腺皮质癌（ACC）罕见，治疗选择有限；SIRT用于ACC肝转移的证据仅有病例报告。一名49岁患ACC的男性患者，此前接受了左侧肝切除术，现采用选择性体内放射治疗（SIRT）来治疗复发性肝转移。该患者在查阅了关于米托坦化疗及其毒性的文献后选择了SIRT。选择性体内放射治疗（SIRT）使患者获得了数月的无进展生存期（PFS），且无毒性反应，放射学反应良好。该患者在初次诊断12年后出现骨转移，于2022年9月不幸去世。ACC的有效治疗存在大量未满足的需求，75%的患者表现为无法治愈的疾病。在该患者中，尽管疾病广泛扩散，但SIRT仍提供了2年的无进展生存期；耐受性良好，肝脏残留损害最小。其在ACC肝脏局限性疾病中的应用值得研究。
肾上腺皮质癌（ACC）是一种罕见且侵袭性强的肿瘤，治疗方法有限。一旦发生转移性疾病，现有的标准治疗方案总体生存率不佳，且毒性显著。选择性体内放射治疗（SIRT）可能代表了肝脏局限性、转移性ACC治疗模式中的一种新干预措施。在此，我们报告一例多次接受SIRT治疗复发性、肝脏局限性ACC的患者，生存期延长了数年。复发性SIRT使肝功能得以维持且无毒性反应。虽然几乎没有证据概述其在ACC中的应用，但考虑到目前有限的治疗前景，肯定有必要进一步研究以确定SIRT的价值。
