A study published in the Journal of Clinical Oncology has detailed the benefits of different forms of treatment for pediatric patients with adrenocortical carcinoma. These researchers particularly looked at what treatments were best for different stages of the disease. The lead author of this study was Carlos Rodriguez-Galindo.
The Study
This study included a total of 77 children with various stages of adrenocortical carcinoma. The patients all enrolled between the years 2006 and 2013.
Each child received a different treatment based on their stage of disease. Those with stage 1 were given adrenalectomy. These patients had a median age of 1.5 years and there were a total of 24 people in this group. Those with stage 2 were given adrenalectomy as well as retroperitoneal lymph node dissection. There were a total of 15 patients in this group.
Finally, those with stage 3 disease (24 patients with a median age of 3 years) and those with stage 4 disease (14 patients with a median age of 13 years) were given chemotherapy as well as mitotane. These patients underwent a total of 8 cycles of chemotherapy using cisplatin, doxorubicin, and etoposide in addition to the mitotane for 8 months. These patients also underwent surgery when needed.
Some patients had to stop chemotherapy after experiencing toxicity and some had to stop mitotane for the same reason.
The following are the estimated 5-year event-free survival rates-
- Stage 1 – 86.2%
- Stage 2 – 53.3%
- Stage 3 – 81%
- Stage 4 – 7.1%
The estimates for overall survival were as follows-
- Stage 1 – 95.2%
- Stage 2 – 78.8 %
- Stage 3 – 94.7%
- Stage 4 – 15.6%
Hazard ratios were as follows-
- Stage 1 – 4.3
- Stage 2 – .92
- Stage 3 – 9.4
- Stage 4 – 3.8
Ultimately, the researchers concluded that the outcomes for patients in stage 1 are great with surgery. Those with stage 2 disease have worse outcomes even with lymph node dissection. Patients in stage 3 had great outcomes with the chemotherapy and surgery combination. Finally, those with stage 4 tend to have poorer outcomes overall. The researchers emphasize the need for more research, specifically for this group. Unfortunately, many of the patients had toxicity reactions to chemotherapy and mitotane.
You can read more about this study and its findings here.
