IMPACT OF ADJUVANT MITOTANE ON THE CLINICAL COURSE OF PATIENTS WITH ADRENOCORTICAL CANCER

Background. Adrenocortical carcinoma is a rare and aggressive disease with a poor prognosis. Adjuvant mitotane administration has been sugge sted as a strategy that might improve the outcome of patients with loc alized disease. Methods. The authors analyzed the clinical outcome of patients with localized or regional adrenocortical cancer. The study i ncluded 19 patients who were registered at M. D. Anderson Cancer Cente r during a 3-year period and who had localized or regional disease at the time of surgery. Of these, eight patients received mitotane postop eratively and continued the drug until their last contact or recurrenc e (Group A, adjuvant); five patients began taking mitotane after surge ry but discontinued it after 2-12 months for reasons unrelated to the disease (Group P, postoperative); and six patients did not receive mit otane (Group N, no mitotane). All patients have been followed for at l east 12 months. Results. The treatment groups differed significantly i n their time to recurrence; the disease-free interval was shortest in Group A (P = 0.0055, by log-rank test). There was no statistical diffe rence in survival among the groups, but the profile remained unfavorab le for Group A. The 2-year survival rate was 100% for Groups N and P b ut only 43% for Group A. Of the potentially confounding factors, gende r, age, steroid hypersecretion, and tumor size, none had any influence on recurrence or survival rates. Conclusions. These findings do not s upport the conclusion that adjuvant mitotane is beneficial in patients with localized or regional adrenocortical cancer. Neither the disease -free interval nor survival was improved by the drug. The authors sugg est that alternative therapeutic strategies be explored for the manage ment of these patients.