Treatment of adrenal carcinomas.

Twenty-three patients with adrenal carcinoma were treated between 1953 and 1981. Six patients underwent resection of the primary tumor and/or local radiation therapy but received no chemotherapy. Their mean survival (+/- SD) was 10.3 +/- 8.7 months. In contrast, 17 patients who were treated with mitotane had a mean survival of 46.6 +/- 42.7 months. Response to therapy depended on when in the course of the disease chemotherapy was instituted, and on the combination of surgical excision and drug treatment of recurrent disease. Longest survival was observed in patients who received mitotane as adjuvant therapy before clinical evidence of metastases was noted and in those who were treated with mitotane and underwent subsequent surgery for recurrent tumor. Mean survival for this group was significantly longer, 74 +/- 33 months, than for the other patients. Patients treated in this series received low-dose long-term therapy. Adverse effects of mitotane were found to be dose dependent.