OPTIMAL TREATMENT OF ADRENOCORTICAL CARCINOMA WITH MITOTANE - RESULTSIN A CONSECUTIVE SERIES OF 96 PATIENTS

Mitotane is considered to be the drug of choice for patients with inop erable, recurrent and metastatic adrenocortical carcinoma, although a favourable effect of this drug on survival has never been documented. We evaluated the efficacy of mitotane treatment of 96 patients with ad renocortical carcinoma followed up in our department between 1959 and 1992. Complete tumour resection was the goal of the initial treatment. Mitotane treatment was classified according to serum trough concentra tions on maintenance therapy: low (<14 mg l(-1)) or high (greater than or equal to 14 mg l(-1)). Total tumour resection was feasible in 47 p atients (49%), and subtotal resection was performed in 37 patients (39 %). Patients who underwent total tumour resection survived significant ly longer than those who did not (P<0.001). Adjuvant mitotane therapy (n = 11) did not influence survival after total resection. Sixty-two p atients were given mitotane treatment at some time during their illnes s, only 30 of whom reached high maintenance serum levels. Mitotane tre atment with high serum levels had an independently favourable influenc e on patient survival, using univariate (P<0.01) and multivariate anal ysis (P = 0.01). Mitotane treatment resulting in low serum levels was tantamount to not giving mitotane at all. We conclude that mitotane tr eatment in adrenocortical carcinoma is effective only when high serum levels can be achieved.