Background Adrenocortical carcinoma is a rare neoplasm characterizedby a high risk of recurrence after radical resection. Whetherthe use of mitotane is beneficial as an adjuvant treatment hasbeen controversial. Our aim was to evaluate the efficacy ofadjuvant mitotane in prolonging recurrence-free survival.
Methods We performed a retrospective analysis involving 177patients with adrenocortical cancer who had undergone radicalsurgery at 8 centers in Italy and 47 centers in Germany between1985 and 2005. Adjuvant mitotane was administered to 47 Italianpatients after radical surgery (mitotane group), whereas 55Italian patients and 75 German patients (control groups 1 and2, respectively) did not receive adjuvant treatment after surgery.
Results Baseline features in the mitotane group and the controlgroup from Italy were similar; the German patients were significantlyolder (P=0.03) and had more stage I or II adrenocortical carcinomas(P=0.02) than did patients in the mitotane group. Recurrence-freesurvival was significantly prolonged in the mitotane group,as compared with the two control groups (median recurrence-freesurvival, 42 months, as compared with 10 months in control group1 and 25 months in control group 2). Hazard ratios for recurrencewere 2.91 (95% confidence interval [CI], 1.77 to 4.78; P<0.001)and 1.97 (95% CI, 1.21 to 3.20; P=0.005), respectively. Multivariateanalysis indicated that mitotane treatment had a significantadvantage for recurrence-free survival. Adverse events associatedwith mitotane were mainly of grade 1 or 2, but temporary dosereduction was needed in 13% of patients.
Conclusions Adjuvant mitotane may prolong recurrence-free survivalin patients with radically resected adrenocortical carcinoma.
Source Information
From the Università di Torino, Turin, Italy (M.T., A.A., F.D., R.R., P.S., G.R., E.B., M.P., E.A., L.D., A.B.); University of Würzburg, Würzburg, Germany (M.F., S.H., A.-C.K., B. Allolio); Università Federico II di Napoli, Naples, Italy (L.T., G.L.); Università di Padova, Padua, Italy (P.A.C., F.M.); Università di Firenze, Florence, Italy (L.B., M.M.); Ospedale Niguarda Milano (E.G., P.L.) and Università di Milano (B. Ambrosi) — both in Milan; Institute of Pathology, Marienkrankenhaus, Hamburg, Germany (W.S.); and Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy (P.B.).
Address reprint requests to Dr. Terzolo, Medicina Interna I, A.S.O. San Luigi, Regione Gonzole 10, 10043 Orbassano, Italy, or at terzolo{at}usa.net.
Adjuvant Mitotane in Adrenocortical Carcinoma
Bertherat J., Coste J., Bertagna X., Dickstein G., Shechner C., Nativ O., Lee J. E., Machens A., Dralle H., Terzolo M., Fassnacht M., Berruti A.
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N Engl J Med 2007;
357:1256-1259, Sep 20, 2007.
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