ADRENOCORTICAL CARCINOMA DIAGNOSTIC AND THERAPEUTIC IMPLICATIONS

Objective: To evaluate the results of treatment of a consecutive serie s of patients with adrenocortical carcinoma who presented during the s ix year period 1985 to 1991. Design: Open study. Setting: Departments of Surgery, Pathology, Endocrinology, and Clinical Chemistry, Sahlgren Hospital, Goteborg, Sweden. Subjects: 10 consecutive patients, two wi th recurrent and eight with primary adrenocortical carcinoma. Interven tions: All patients were treated surgically. Two required preoperative embolisation of the tumour vessels to facilitate excision of particul arly large tumours, and eight were given adjuvant treatment with mitot ane (o,p'-DDD). Results: At a median follow up of 1. 5 years (range 3 months, to 21 years) 6 patients were alive with no radiological or bio chemical signs of disease; 2 were alive, but with signs of recurrence (at 3 months and 6 years, respectively); and two had died of their dis ease (at 4 and 8 months, respectively). For the past two years all pat ients have had their urinary steroid profiles monitored by gas chromat ography and mass spectrometry to detect recurrence of the tumour at th e earliest possible stage. Conclusion: Operation is the treatment of c hoice for patients with adrenocortical carcinoma, particularly stages I-III. The role of mitotane as adjuvant treatment can be evaluated onl y in multicentre studies.