부산대학교 도서관

Simple Summary: Local therapies (LTs) are suggested by most experts and guidelines for the treatment of advanced ACC. However, there are only a few published studies on LTs, and there are no clear recommendations regarding which patients benefit from which treatments. Therefore, this multicentre cohort study aimed to investigate the outcomes and factors associated with LTs (n = 132) when used as a therapeutic approach in 66 patients with metastatic ACC. These patients were treated with local thermal ablation (LTA, n = 84) therapies, transarterial (chemo)embolisation (TA(C)E, n = 40), and transarterial radioembolisation (TARE, n = 8). In 21% of the treated tumoural lesions, complete remission was achieved. Time to progression of the treated lesion was particularly long in patients treated with LTA (median not yet reached), whereas it was only 8.3 months after TA(C)E and 8.2 months after TARE. Thus, this study provides clear evidence that LTs can be quite efficient in a subgroup of patients with advanced ACC. 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. [ABSTRACT FROM AUTHOR]