Adjunctive treatment of adrenocortical carcinoma

PURPOSE OF REVIEW: Description of the adjunctive treatment strategies in patients with adrenocortical carcinoma after complete surgical resection. RECENT FINDINGS: A retrospective analysis showing that adjuvant mitotane may prolong recurrence-free survival in a large cohort of patients with radically resected adrenocortical carcinoma has recently been published. Debate continues as to whether mitotane may, however, be beneficial as an adjuvant treatment. SUMMARY: Radical surgical resection of adrenocortical carcinoma offers the best chance for prolonged recurrence-free survival; however, a significant number of patients without objective and biochemical evidence of residual tumor after surgery are destined to relapse. Mitotane, an analogue of the insecticide dichlorodiphenyltrichloroethane, has been used for treatment of advanced adrenocortical carcinoma since the 1960s, but its use as an adjunctive postoperative measure has remained controversial. Adjunctive treatments different from mitotane have been employed infrequently; a recent retrospective study showed benefit of local radiotherapy. The recent demonstration that mitotane treatment following macroscopically complete removal of adrenocortical carcinoma was associated with beneficial effects on outcome in a well designed, multicenter, international study should renew interest in adjuvant mitotane therapy.