International guidelines recommend local therapies (LTs) such as local thermal ablation (LTA; radiofrequency, microwave, cryoablation), transarterial (chemo)embolisation (TA(C)E), and transarterial radioembolisation (TARE) as therapeutic options for advanced adrenocortical carcinoma (ACC). However, the evidence for these recommendations is scarce. We retrospectively analysed patients receiving LTs for advanced ACC. Time to progression of the treated lesion (tTTP) was the primary endpoint. The secondary endpoints were best objective response, overall progression-free survival, overall survival, adverse events, and the establishment of predictive factors by multivariate Cox analyses. A total of 132 tumoural lesions in 66 patients were treated with LTA (n = 84), TA(C)E (n = 40), and TARE (n = 8). Complete response was achieved in 27 lesions (20.5%; all of them achieved by LTA), partial response in 27 (20.5%), and stable disease in 38 (28.8%). For the LTA group, the median tTTP was not reached, whereas it was reached 8.3 months after TA(C)E and 8.2 months after TARE (p< 0.001). The median time interval from primary diagnosis to LT was >47 months. Fewer than four prior therapies and mitotane plasma levels of >14 mg/L positively influenced the tTTP. In summary, this is one of the largest studies on LTs in advanced ACC, and it demonstrates a very high local disease control rate. Thus, it clearly supports the guideline recommendations for LTs in these patients.
国际指南推荐局部治疗（LTs）作为晚期肾上腺皮质癌（ACC）的治疗选择，包括局部热消融（LTA；射频、微波、冷冻消融）、经动脉（化疗）栓塞（TA(C)E）和经动脉放射性栓塞（TARE）。然而，支持这些建议的证据尚不充分。本研究回顾性分析了接受LTs治疗的晚期ACC患者。主要终点为治疗病灶的进展时间（tTTP），次要终点包括最佳客观缓解率、总体无进展生存期、总生存期、不良事件以及通过多变量Cox分析确定预测因素。研究共纳入66例患者的132个肿瘤病灶，分别接受LTA（n=84）、TA(C)E（n=40）和TARE（n=8）治疗。结果显示，27个病灶（20.5%；均为LTA治疗）达到完全缓解，27个（20.5%）达到部分缓解，38个（28.8%）疾病稳定。LTA组的中位tTTP未达到，而TA(C)E组和TARE组的中位tTTP分别为8.3个月和8.2个月（p<0.001）。从初次诊断到接受LT治疗的中位时间间隔超过47个月。既往治疗少于4次且米托坦血浆浓度>14 mg/L对延长tTTP有积极影响。总之，这是关于晚期ACC局部治疗的最大规模研究之一，结果显示局部疾病控制率极高，从而明确支持指南中对此类患者推荐局部治疗的建议。
The Value of Local Therapies in Advanced Adrenocortical Carcinoma
肿瘤(癌症)患者之家