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Clinical Trial
. 2018 Dec:232:383-388.
doi: 10.1016/j.jss.2018.06.012.

A Phase II Trial of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Adrenocortical Carcinoma

Marybeth S Hughes  1 , Winifred M Lo  2 , Tatiana Beresnev  2 , Maria Merino  3 , Yvonne Shutack  2 , R Taylor Ripley  2 , Jonathan M Hernandez  2 , Jeremy L Davis  4
Affiliations
Clinical Trial

A Phase II Trial of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Adrenocortical Carcinoma

Marybeth S Hughes et al. J Surg Res. 2018 Dec.

Abstract

Background: Recurrent adrenocortical carcinoma (ACC) is an aggressive disease with few options offering durable survival benefit. Despite metastasectomy, recurrence is common. Cytoreduction and intraperitoneal chemotherapy have offered improved survival in other advanced cancers. We sought to evaluate the use of cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of recurrent intraperitoneal ACC.

Methods: A phase II, single institution clinical trial was approved for patients with radiographic evidence of resectable ACC limited to the peritoneum. Patients underwent treatment if optimal cytoreduction was deemed possible at exploratory laparotomy. Primary outcome was intraperitoneal progression-free survival. Secondary outcomes were treatment-related morbidities and overall survival.

Results: Sixty-three patients were evaluated, of whom 11 met eligibility criteria. Nine patients underwent cytoreduction and HIPEC, including one patient who recurred and was re-treated (n = 10 treatments). One patient could not be optimally cytoreduced for HIPEC and therefore did not receive intraperitoneal chemotherapy. There was no perioperative mortality; perioperative comorbidities were limited to Clavien-Dindo grade 2 or 3 and included hematologic, infectious, and neurologic complications. Seven patients experienced disease recurrence and two patients died of disease during follow-up (median 24 mo). Intraperitoneal progression-free survival was 19 mo, and median overall survival has not yet been reached.

Conclusions: Cytoreduction and HIPEC can be performed safely in selected patients. Patients with recurrent ACC confined to the peritoneal cavity can be considered for regional therapy in experienced hands. However, disease recurrence is common, and other treatment options should be explored.

Keywords: Adrenocortical carcinoma; Cytoreduction; Intraperitoneal chemotherapy.

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Conflict of interest statement

Disclosure

The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Figures

Fig. 1 –
Fig. 1 –
Clinical trial design and enrollment. *1 patient experienced recurrent disease and was re-enrolled for a second CRS and HIPEC procedure.
Fig. 2 –
Fig. 2 –
FACT-G questionnaire QoL scores for cohort (median score shown).
Fig. 3 –
Fig. 3 –
(A) Overall survival of cohort (median survival not yet reached). (B) IP-PFS (median survival 19 mo).
See this image and copyright information in PMC

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