Información del artículo
Resumen
El carcinoma córtico-adrenal es una entidad que se presenta raras veces; su evolución es agresiva, con una alta probabilidad de recaída y una supervivencia a 5 años que no supera el 60%. El único tratamiento curativo es la cirugía, siempre y cuando esta sea completa y a los pacientes se los diagnostique en estadios tempranos. Otras intervenciones que se pueden brindar son la radioterapia, la quimioterapia y el control de secreción hormonal en el contexto adyuvante o paliativo. En algunos casos (síndrome de Cushing) el bloqueo hormonal previo a la cirugía es imperativo.
En esta revisión se describen la patogénesis, el diagnóstico, los factores pronósticos y el tratamiento del carcinoma córtico-adrenal, con el propósito de guiar el enfoque diagnóstico y el tratamiento.
Palabras clave:
Neoplasia de la corteza suprarrenal
metástasis de la neoplasia
tratamiento
Abstract
Adrenal-cortical carcinoma is a rarely occurring entity; it evolves aggressively, has a high probability of relapse and survival at 5 years does not surpass 60%. Surgery provides the only curative treatment, but only when it is complete and carried out on patients with early-stage diagnosis. Additional treatments that may be used include radiotherapy, chemotherapy and control of hormonal secretion in an adjuvant or palliative context. In some cases (Cushing's syndrome), it is imperative to provide hormonal block before surgery. The pathogenesis, diagnosis, prognostic factors and treatment of adrenal-cortical carcinoma are described in this review in order to sharpen the focus on diagnosis and treatment.
Key words:
Neoplasms
adrenal cortex
neoplasm metastasis
therapy
El Texto completo está disponible en PDF
Referencias
[1.]
B.L. Paton, Y.W. Novitsky, M. Zerey, et al.
Outcomes of adrenal cortical carcinoma in the United States.
Surgery, 140 (2006), pp. 914-920
[2.]
D.F. Maluf, B.H. de Oliveira, E. Lalli.
Therapy of adrenocortical cancer: present and future.
Am J Cancer Res, 1 (2011), pp. 222-232
[3.]
Instituto Nacional de Cancerología (INC).
Registro institucional de cáncer. Anuario estadístico 2009.
INC, (2010),
[4.]
Registro Poblacional de Cáncer de Cali, Universidad del Valle. Estadísticas, incidencia, 2007 [internet]. [citado: 18 de abril de 2012]. Disponible en: http://rpcc.univalle.edu.co/es/incidencias/Estadisticas/index.php.
[5.]
M. Terzolo, A. Stigliano, I. Chiodini, et al.
AME position statement on adrenal incidentaloma.
Eur J Endocrinol, 164 (2011), pp. 851-870
[6.]
D.E. Schteingart, G.M. Doherty, P.G. Gauger, et al.
Management of patients with adrenal cancer: recommendations of an international consensus conference.
Endocr Relat Cancer, 12 (2005), pp. 667-680
[7.]
W.F. Young Jr..
Management approaches to adrenal incidentalomas.
Endocrinol Metab Clin North Am, 29 (2000), pp. 159-185
[8.]
K.Y. Bilimoria, W.T. Shen, D. Elaraj, et al.
Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors.
Cancer, 113 (2008), pp. 3130-3136
[9.]
A. Stojadinovic, R.A. Ghossein, A. Hoos, et al.
Adrenocortical carcinoma: clinical, morphologic, and molecular characterization.
J Clin Oncol, 20 (2002), pp. 941-950
[10.]
R. Libe, J. Bertherat.
Molecular genetics of adrenocortical tumours, from familial to sporadic diseases.
Eur J Endocrinol, 153 (2005), pp. 477-487
[11.]
R. Libe, A. Fratticci, J. Bertherat.
Adrenocortical cancer: pathophysiology and clinical management.
Endocr Related Cancer, 14 (2007), pp. 13-28
[12.]
P.S. Soon, K.L. McDonald, B.G. Robinson, et al.
Molecular markers and the pathogenesis of adrenocortical cancer.
Oncologist, 13 (2008), pp. 548-561
[13.]
J. Bertherat, X. Bertagna.
Pathogenesis of adrenocortical cancer.
Best Pract Res Clin Endocrinol Metab, 23 (2009), pp. 261-271
[14.]
F.M. Barlaskar, G.D. Hammer.
The molecular genetics of adrenocortical carcinoma.
Rev Endocr Metab Disord, 8 (2007), pp. 343-348
[15.]
B. Allolio, M. Fassnacht.
Clinical review: Adrenocortical carcinoma: clinical update.
J Clin Endocrinol Metab, 91 (2006), pp. 2027-2037
[16.]
M. Wandoloski, K.J. Bussey, M.J. Demeure.
Adrenocortical cancer.
Surg Clin N Am, 89 (2009), pp. 1255-1267
[17.]
M. Fassnacht, B. Allolio.
Clinical management of adrenocortical carcinoma.
Best Pract Res Clin Endocrinol Metab, 23 (2009), pp. 273-289
[18.]
R. Kumar, A. Alavi, S. Fanti.
Adrenocortical positron emission tomography/PET-CT Imaging.
PET Clin, 2 (2008), pp. 331-339
[19.]
L.J. Medeiros, L.M. Weiss.
New development in the pathologic diagnosis of adrenal cortical neoplasms-a review.
Am J Clin Pathol, 97 (1992), pp. 73-83
[20.]
J. Hofland de, F.H. de Jong.
Inhibins and activins; their roles in the adrenal gland and the development of adrenocortical tumors.
Mol Cell Endocrinol., (2011 Jun 22),
[21.]
N. Pabón, C. Gómez, G. Garavito, et al.
Carcinoma corticosuprarrenal: estado actual de nuestro conocimiento.
Rev Colomb Cancerol, 9 (2005), pp. 123-129
[22.]
R. Kuruba, S.F. Gallagher.
Current management of adrenal tumors.
Curr Opin Oncol, 20 (2008), pp. 34-46
[23.]
A. Patalano, V. Brancato, F. Mantero.
Adrenocortical cancer treatment.
Horm Res, 71 (2009), pp. 99-104
[24.]
I. Veytsman, L. Nieman, T. Fojo.
Management of endocrine manifestations and the use of mitotane as a chemotherapeutic agent for adrenocortical carcinoma.
J Clin Oncol, 27 (2009), pp. 4619-4629
[25.]
D.E. Schteingart.
Adjuvant mitotane therapy of adrenal cancer - use and controversy.
N Engl J Med, 356 (2007), pp. 2415-2418
[26.]
F. Daffara, S. De Francia, G. Reimondo, et al.
Prospective evaluation of mitotane toxicity in adrenocortical cancer patients treated adjuvantly.
Endocr Relat Cancer, 15 (2008), pp. 1043-1053
[27.]
B.D. Saunders, G.M. Doherty.
Laparoscopic adrenalectomy for malignant disease.
Lancet Oncol, 5 (2004), pp. 718-726
[28.]
H. Suzuki.
Laparoscopic adrenalectomy for adrenal carcinoma and metastases.
Curr Opin Urol, 16 (2006), pp. 47-53
[29.]
R. Bellantone, A. Ferrante, M. Boscherini, et al.
Role of reoperation in recurrence of adrenal cortical carcinoma.
Surgery, 122 (1997), pp. 1212-1218
[30.]
A. Berruti, M. Fassnacht, E. Baudin, et al.
Adjuvant therapy in patients with adrenocortical carcinoma: a position of an international panel.
J Clin Oncol, 28 (2010), pp. e401-e402
[31.]
M. Terzolo, A. Angeli, M. Fassnacht, et al.
Adjuvant mitotane treatment for adrenocortical carcinoma.
N Engl J Med, 356 (2007), pp. 2372-2380
[32.]
G.G. Fareau, A. López, C. Stava, et al.
Systemic chemotherapy for adrenocortical carcinoma: comparative responses to conventional first-line therapies.
Anti-cancer Drugs, 19 (2008), pp. 637-644
[33.]
A. Berruti, M. Terzolo, P. Sperone, et al.
Etoposide, doxorubicin and ci splat in plus mitotane in the treatment of advanced adrenocortical carcinoma: a large prospective phase II trial.
Endocr Related Cancer, 12 (2005), pp. 657-666
[34.]
T.S. Khan, H. Imam, C. Juhlin, et al.
Streptozotocin and o,p’DDD in the treatment of adrenocortical cancer patients: long-term survival in its adjuvant use.
Ann Oncol, 11 (2000), pp. 1281-1287
[35.]
M. Fassnacht, M. Terzolo, B. Allolio, et al.
Etoposide, doxorubicin, cisplatin, and mitotane versus streptozotocin and mitotane in adrenocortical carcinoma: preliminary results from the first international phase III trial: the FIRM-ACT study.
Endocrine Abstracts, 26 (2011),
[36.]
S. Wortmann, M. Quinkler, C. Ritter, et al.
Bevacizumab plus capecitabine as a salvage therapy in advanced adrenocortical carcinoma.
Eur J Endocrinol, 162 (2010), pp. 349-356
[37.]
M. Quinkler, S. Hahner, S. Wortmann, et al.
Treatment of advanced adrenocor tical carcinoma with erlotinib plus gemcitabine.
J Clin Endocrinol Metab, 93 (2008), pp. 2057-2062
[38.]
V. Samnotra, R. Vassilopoulou-Sellin, A. Fojo, et al.
A phase II trial of gefitinib monotherapy in patients with unresectable adrenocortical carcinoma (ACC).
J Clin Oncol, 25 (2007), pp. 15527
[39.]
A. Berruti, P. Sperone, A. Ferrero, et al.
Phase II study of weekly paclitaxel and sorafenib as second/third line therapy in patients with adrenocartical carcinoma.
Eur J Endocrinol, 166 (2012), pp. 451-458
[40.]
P. Sperone, A. Ferrero, F. Daffara, et al.
Gemcitabine plus metronomic 5-fluorouracil or capecitabine as a second-/third-line chemotherapy in advanced adrenocortical carcinoma: a multicenter phase II study.
Endocr Related Cancer, 17 (2010), pp. 445-453
[41.]
J.O. Lee, K.W. Lee, C.J. Kim, et al.
Metastatic adrenocortical carcinoma treated with sunitinib: a case report.
Jpn J Clin Oncol, 39 (2009), pp. 183-185
[42.]
R. Chacon, G. Tossen, F.S. Loria, et al.
Response in a patient with metastatic adrenal cortical carcinoma with thalidomide.
J Clin Oncol, 23 (2005), pp. 1579-1580
[43.]
A. Salboch, M. Feng, K. Griffith, et al.
Adjuvant and definitive radiotherapy for adrenocortical carcinoma.
Int J Radiat Oncol Biol Phys, 80 (2011), pp. 1477-1484
[44.]
B. Polat, M. Fassnacht, L. Pfreunder, et al.
Radiotherapy in adrenocortical carcinoma.
Cancer, 115 (2009), pp. 2816-2823
Copyright © 2012. Instituto Nacional de Cancerología
