TY  - JOUR
A1  - Kimpel, Otilia
A1  - Schindler, Paul
A1  - Schmidt-Pennington, Laura
A1  - Altieri, Barbara
A1  - Megerle, Felix
A1  - Haak, Harm
A1  - Pittaway, James
A1  - Dischinger, Ulrich
A1  - Quinkler, Marcus
A1  - Mai, Knut
A1  - Kroiss, Matthias
A1  - Polat, Bülent
A1  - Fassnacht, Martin
T1  - Efficacy and safety of radiation therapy in advanced adrenocortical carcinoma
JF  - British Journal of Cancer
N2  - Background
International guidelines emphasise the role of radiotherapy (RT) for the management of advanced adrenocortical carcinoma (ACC). However, the evidence for this recommendation is very low.

Methods
We retrospectively analysed all patients who received RT for advanced ACC in five European centres since 2000. Primary endpoint: time to progression of the treated lesion (tTTP). Secondary endpoints: best objective response, progression-free survival (PFS), overall survival (OS), adverse events, and the establishment of predictive factors by Cox analyses.

Results
In total, 132 tumoural lesions of 80 patients were treated with conventional RT (cRT) of 50–60 Gy (n = 20) or 20–49 Gy (n = 69), stereotactic body RT of 35–50 Gy (SBRT) (n = 36), or brachytherapy of 12–25 Gy (BT) (n = 7). Best objective lesional response was complete (n = 6), partial (n = 52), stable disease (n = 60), progressive disease (n = 14). Median tTTP was 7.6 months (1.0–148.6). In comparison to cRT\(_{20-49Gy}\), tTTP was significantly longer for cRT\(_{50-60Gy}\) (multivariate adjusted HR 0.10; 95% CI 0.03–0.33; p < 0.001) and SBRT (HR 0.31; 95% CI 0.12–0.80; p = 0.016), but not for BT (HR 0.66; 95% CI 0.22–1.99; p = 0.46). Toxicity was generally mild and moderate with three grade 3 events. No convincing predictive factors could be established.

Conclusions
This largest published study on RT in advanced ACC provides clear evidence that RT is effective in ACC.
KW  - adrenal tumours
KW  - adrenocortical carcinoma (ACC)
KW  - radiotherapy (RT)
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324411
VL  - 128
IS  - 4
ER  - 
TY  - JOUR
A1  - Kimpel, Otilia
A1  - Altieri, Barbara
A1  - Dischinger, Ulrich
A1  - Fuss, Carmina Teresa
A1  - Kurlbaum, Max
A1  - Fassnacht, Martin
T1  - Early detection of recurrence and progress using serum steroid profiling by LC–MS/MS in patients with adrenocortical carcinoma
JF  - Metabolites
N2  - Serum liquid chromatography–tandem mass spectrometry (LC–MS/MS) steroid profiling is used for the diagnosis of adrenocortical carcinoma (ACC). Guidelines recommend endocrine work-up in addition to radiological imaging for follow-up in ACC, but data on this topic are scarce. Patients were included in this retrospective study if pre-therapeutic hormone values, regular tumour evaluation by imaging, steroid measurements by LC–MS/MS, and details on therapies were available. The utility of steroid profiles in detecting recurrence or disease progression was assessed, whereby “endocrine progress” was defined by an elevation of at least 3 of 13 analysed hormones. Cohort A included 47 patients after R0 resection, of whom 15 experienced recurrence and 32 did not. In cohort B, 52 patients with advanced disease (including 7 patients of cohort A with recurrence) could be evaluated on 74 visits when progressive disease was documented. In 20 of 89 cases with documented disease progression, “endocrine progress” was detectable prior to radiological progress. In these cases, recurrence/progression was detected at a median of 32 days earlier by steroid measurement than by imaging, with 11-deoxycortisol and testosterone being the most sensitive markers. Notably, these patients had significantly larger tumour burden. In conclusion, steroid profiling by LC–MS/MS is of value in detecting recurrent/progressive disease in ACC.
KW  - adrenal cancer
KW  - follow-up
KW  - steroid measurement
KW  - liquid chromatography–tandem mass spectrometry (LC–MS/MS)
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-355839
SN  - 2218-1989
VL  - 14
IS  - 1
ER  -