Sen Lu1, Jasreman Dhillon2, Julie Hallanger Johnson3, Ghassan El-Haddad4. 1. Department of Diagnostic and Interventional Radiology, University of South Florida, 2 Tampa General Circle, STC 7028, Tampa, FL, 33606, USA. lus@usf.edu. 2. Department of Pathology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA. 3. Department of Endocrinology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA. 4. Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
Abstract
BACKGROUND: Adrenocortical carcinoma (ACC) is an uncommon malignancy with an estimated 15,400 new cases annually across the globe. The prognosis is generally poor as the disease is often already advanced at initial diagnosis due to non-specific symptoms. Even for local disease, recurrence after surgical resection is high. Treatment choices for advanced disease include mitotane, chemotherapy, ablation, chemoembolization, radioembolization, and external beam radiotherapy, with varying degrees of efficacy. To the best of our knowledge, there have only been two prior case studies of complete clinical and radiological response of stage 4 disease at 1 year and 2 years after yttrium-90 (90Y) microsphere selective internal radiation therapy (SIRT) of isolated hepatic metastases post-surgery and chemotherapy. CASE PRESENTATION: We present a case of a 58-year-old man with metastatic ACC who was treated with 90Y resin microsphere (SIR-spheres) for local control of liver metastases leading to a surgically proven negative pathology after partial hepatectomy 7 months after SIRT. The patient was initially diagnosed with stage 1 ACC that progressed 6 years later to stage 4 disease with new liver metastases that were deemed unresectable at an outside institution. After review of the case at multidisciplinary tumor board, he was referred for liver directed therapy for local tumor control. Angiographic workup demonstrated partial extrahepatic supply to the tumors from the right inferior phrenic artery, which was successfully embolized on the day of SIRT for flow redistribution. As the patient was being treated with mitotane that suppresses steroid production, he developed post-SIRT adrenal crisis, which was successfully controlled with steroids, highlighting the need for pre SIRT stress dose steroids. CONCLUSIONS: This case continues to add to the literature supporting 90Y radioembolization as an effective treatment for isolated hepatic ACC metastases. Our case is the first to demonstrate surgically proven negative pathology after radioembolization. Further prospective study is warranted to better establish efficacy as well as safety of SIRT for ACC liver metastases.
BACKGROUND:Adrenocortical carcinoma (ACC) is an uncommon malignancy with an estimated 15,400 new cases annually across the globe. The prognosis is generally poor as the disease is often already advanced at initial diagnosis due to non-specific symptoms. Even for local disease, recurrence after surgical resection is high. Treatment choices for advanced disease include mitotane, chemotherapy, ablation, chemoembolization, radioembolization, and external beam radiotherapy, with varying degrees of efficacy. To the best of our knowledge, there have only been two prior case studies of complete clinical and radiological response of stage 4 disease at 1 year and 2 years after yttrium-90 (90Y) microsphere selective internal radiation therapy (SIRT) of isolated hepatic metastases post-surgery and chemotherapy. CASE PRESENTATION: We present a case of a 58-year-old man with metastatic ACC who was treated with 90Y resin microsphere (SIR-spheres) for local control of liver metastases leading to a surgically proven negative pathology after partial hepatectomy 7 months after SIRT. The patient was initially diagnosed with stage 1 ACC that progressed 6 years later to stage 4 disease with new liver metastases that were deemed unresectable at an outside institution. After review of the case at multidisciplinary tumor board, he was referred for liver directed therapy for local tumor control. Angiographic workup demonstrated partial extrahepatic supply to the tumors from the right inferior phrenic artery, which was successfully embolized on the day of SIRT for flow redistribution. As the patient was being treated with mitotane that suppresses steroid production, he developed post-SIRT adrenal crisis, which was successfully controlled with steroids, highlighting the need for pre SIRT stress dose steroids. CONCLUSIONS: This case continues to add to the literature supporting 90Y radioembolization as an effective treatment for isolated hepatic ACC metastases. Our case is the first to demonstrate surgically proven negative pathology after radioembolization. Further prospective study is warranted to better establish efficacy as well as safety of SIRT for ACC liver metastases.
Authors: Dwight H Owen; Sandipkumar Patel; Lai Wei; John E Phay; Lawrence A Shirley; Lawrence S Kirschner; Carl Schmidt; Sherif Abdel-Misih; Pamela Brock; Manisha H Shah; Bhavana Konda Journal: Horm Cancer Date: 2019-08-29 Impact factor: 3.869
Authors: André P Fay; Aymen Elfiky; Gabriela H Teló; Rana R McKay; Marina Kaymakcalan; Paul L Nguyen; Anand Vaidya; Daniel T Ruan; Joaquim Bellmunt; Toni K Choueiri Journal: Crit Rev Oncol Hematol Date: 2014-06-04 Impact factor: 6.312
Authors: Alfredo Berruti; Massimo Terzolo; Paola Sperone; Anna Pia; Silvia Della Casa; David J Gross; Carlo Carnaghi; Paolo Casali; Francesco Porpiglia; Franco Mantero; Giuseppe Reimondo; Alberto Angeli; Luigi Dogliotti Journal: Endocr Relat Cancer Date: 2005-09 Impact factor: 5.678
Authors: Martin Fassnacht; Massimo Terzolo; Bruno Allolio; Eric Baudin; Harm Haak; Alfredo Berruti; Staffan Welin; Carmen Schade-Brittinger; André Lacroix; Barbara Jarzab; Halfdan Sorbye; David J Torpy; Vinzenz Stepan; David E Schteingart; Wiebke Arlt; Matthias Kroiss; Sophie Leboulleux; Paola Sperone; Anders Sundin; Ilse Hermsen; Stefanie Hahner; Holger S Willenberg; Antoine Tabarin; Marcus Quinkler; Christelle de la Fouchardière; Martin Schlumberger; Franco Mantero; Dirk Weismann; Felix Beuschlein; Hans Gelderblom; Hanneke Wilmink; Monica Sender; Maureen Edgerly; Werner Kenn; Tito Fojo; Hans-Helge Müller; Britt Skogseid Journal: N Engl J Med Date: 2012-05-02 Impact factor: 91.245
Authors: Gergely Huszty; Attila Doros; Katalin Farkas; László Kóbori; Péter Reismann; Judit Tőke; Miklós Tóth; Peter Igaz Journal: Front Endocrinol (Lausanne) Date: 2021-04-30 Impact factor: 5.555