This protocol covers the next treatment step for patients with advanced adrenocortical carcinoma who present with a limited burden of intra-abdominal or extra-abdominal metastases amenable to local treatment, but in whom the initial local approach has not met its clinical goals.
Advanced ACC with limited metastatic spread — intra-abdominal or extra-abdominal — where lesions were considered suitable for local intervention. Surgical resection and local ablative or radiation-based measures, combined with early mitotane, form the initial management strategy in this setting.
The preceding step combined surgical resection of lesions (where complete resection was feasible) or, alternatively, adrenal tumour resection together with other local measures — radiation therapy, radiofrequency ablation, cryoablation, microwave ablation, or chemoembolization — to control remaining lesions, with mitotane started as early as clinically possible. Escalation to this protocol is triggered when the target mitotane blood level and adequate tumour control have not been achieved.
When more aggressive therapy is indicated, the validated approach involves a multi-agent chemotherapy combination given alongside mitotane, with the aim of reaching a defined therapeutic blood level and achieving tumour response or long-term stable disease — the complete protocol details are available via the link below.
DOI: 10.1530/EJE-18-0608