A place for adjuvant mitotane treatment in low-risk patients with adrenocortical carcinoma – case report
Journal Title: Postępy Nauk Medycznych - Year 2013, Vol 26, Issue 11
Abstract
We present a case of a 56-year-old women treated for hypertension with tumor of adrenal gland confirmed on CT in 2006, sized 16 x 18 mm with pre-contrast density about 30 Hounsfield Units. She hadn’t decided to undergo further evaluation and only the ultrasound of the abdomen was performed annually for four years. In 2010, as soon as enlarging of the mass was revealed, the clinical evaluation was performed which led to suspicion of adrenocortical carcinoma. The patient underwent margin-free complete laparoscopic resection of the tumor (R0) and was classified as stage I (ENSAT) adrenocortical carcinoma with low-risk of recurrence (Ki-67 index < 10%, resection status R0). According to current clinical oncological guidelines, she was not administered adjuvant mitotane from oncologist. The treatment started two months later, but it was four years after the tumors had been found. Two years after the surgery metastases occurred, and one year later the patient died. There is high probability of existing occult micrometastases at the time of diagnosis even in patients with low-risk and low stage of the disease. The data obtained from several studies indicate that such patients may benefit from administering adjuvant mitotane. Delay in treatment with mitotane may lead to faster recurrence of ACC and worsen the survival, as happened to the presented patient. Results of the first prospective, randomized trial (ADIUVO trial) are expected in 2014. They will hopefully lead to unified recommendations in low-risk patients with stage I or II of the disease.
Authors and Affiliations
Karolina Nowak, Lucyna Papierska
Keywords
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