Adjuvant radiotherapy for the primary treatment of adrenocortical carcinoma: are we offering the best?

ABSTRACT Purpose: To evaluate the role of ARDT after surgical resection of ACC. Materials and Methods: Records of patients from our institutional ACC database were retrospectively assessed. A paired comparison analysis was used to evaluate the oncological outcomes between patients treated with surgery followed by ARDT or surgery only (control). The endpoints were LRFS, RFS, and OS. A systematic review of the literature and meta-analysis was also performed to evaluate local recurrence of ACC when ARDT was used. Results: Ten patients were included in each Group. The median follow-up times were 32 months and 35 months for the ARDT and control Groups, respectively. The results for LRFS (p=0.11), RFS (p=0.92), and OS (p=0.47) were similar among subsets. The mean time to present with local recurrence was significantly longer in the ARDT group compared with the control Group (419±206 days vs. 181±86 days, respectively; p=0.03). ARDT was well tolerated by the patients; there were no reports of late toxicity. The meta-analysis, which included four retrospective series, revealed that ARDT had a protective effect on LRFS (HR=0.4; CI=0.17-0.94). Conclusions: ARDT may reduce the chance and prolong the time to ACC local recurrence. However, there were no benefits for disease recurrence control or overall survival for patients who underwent this complementary therapy.

摘要
研究目的：评估肾上腺皮质癌（Adrenocortical Carcinoma, ACC）患者术后接受辅助放射治疗（Adjuvant Radiation Therapy, ARDT）的作用。
材料与方法：回顾性评估本机构ACC数据库内的患者病历。采用配对比较分析，对比仅接受手术治疗（对照组）与手术联合ARDT治疗的患者的肿瘤学结局。研究终点为局部无复发生存期（Local Recurrence-Free Survival, LRFS）、无复发生存期（Recurrence-Free Survival, RFS）及总生存期（Overall Survival, OS）。此外，本研究还开展了系统文献回顾与荟萃分析，以评估ARDT用于ACC治疗时的局部复发情况。
结果：两组各纳入10例患者。辅助放射治疗组与对照组的中位随访时间分别为32个月与35个月。两组在LRFS（p=0.11）、RFS（p=0.92）及OS（p=0.47）方面的结局均无显著差异。但辅助放射治疗组出现局部复发的平均时间显著长于对照组（分别为419±206天与181±86天；p=0.03）。患者对ARDT的耐受性良好，未出现晚期毒性反应报告。纳入4项回顾性队列研究的荟萃分析结果显示，ARDT对LRFS具有保护作用（风险比Hazard Ratio, HR=0.4；95%置信区间Confidence Interval, CI=0.17-0.94）。
结论：ARDT可降低ACC患者局部复发的风险，并延长局部复发的发生时间。但该辅助治疗方案并未改善患者的疾病复发控制效果或总生存期。