What are the ESMO guidelines on the diagnosis and treatment of adrenocortical carcinomas (ACC)?

Updated: Dec 23, 2018
  • Author: Evan S Ong, MD, MS; more...
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Answer

Answer

The European Society for Medical Oncology (ESMO) guidelines utilize the 2005 proposed diagnostic workup of the European Network for the Study of Adrenal Tumors (ENSAT) for evaluation of possible adrenocortical carcinomas (ACC), which includes a detailed endocrine assessment and comprehensive hormonal analysis. Additional recommendations include the following [10] :

  • Open surgery with transperitoneal access for stages I-III when complete resection is possible

  • Laparoscopic adrenalectomy only for selected patients with small tumors and no evidence of invasiveness or adrenal incidentalomas

  • Margin-free complete resection of locally advanced ACC may require resection of parts of adjacent organs

  • Re-resection of ACC for recurrence, if margin-free resection is possible and the time to recurrence was >12 months

  • Adjuvant mitotane therapy in patients with incomplete/R1 or Rx resection and/or Ki67 expression in ≤10% of neoplastic cells

  • For bone metastasis, palliative radiotherapy is an option; arterial chemoembolization and radiofrequency ablation may be beneficial in selected patients


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