This protocol applies to patients with adrenocortical carcinoma who develop recurrence after a disease-free interval of at least 12 months, and in whom the recurrent lesion is amenable to complete removal or ablation.
Recurrent adrenocortical carcinoma — disease-free interval of at least 12 months — with recurrence that can be completely resected or ablated. This specific combination of favourable disease-free interval and technically feasible local control defines the population for this protocol.
The recommended strategy centres on a local intervention targeting the recurrent lesion — surgical or ablative — followed by initiation of systemic therapy as soon as possible after the intervention. Full selection criteria, sequencing, and all treatment details are in the complete protocol.
Monitoring of mitotane blood concentration is recommended throughout treatment. The general clinical aim is to achieve and maintain a blood level above 14 mg/L; the complete target parameters and monitoring schedule are detailed in the full protocol.
DOI: 10.1530/EJE-18-0608
In patients with recurrent disease and a disease-free interval of at least 12 months, in whom a complete resection/ablation seems feasible, we recommend surgery or alternatively other local therapies (+OOO).
We recommend starting mitotane as soon as possible after the intervention.
We recommend monitoring of blood concentration of mitotane. The general aim is to reach a mitotane blood level above 14 mg/L (+OOO).