Aims and objectives
Adrenocortical carcinoma (ACC) is a very uncommon disease,
with an incidence of approximately 1-2 per million per year in the United Statesand a prevalence <0,1 per 10000.
On the other hand,
it is a very aggressive tumor,
with a poor prognosis.
Patients with apparently localized disease can be treated by complete surgical resection,
however,
ACC is associated with a high recurrence rate and metastatic disease frequently develops within 6-24 months.Furthermore 25% to 30% of patients already show metastatic disease at diagnosis.The most common metastatic sites...
Methods and materials
We performed RFA or MWA in 16 patients (age range 22-62 years,
mean 42 years)with hepatic or lung metastases from ACC.
All patients had undergone adrenalectomy.A total of 28 liver metastases and 4 lung metastases were treated.The size of the lesion ranged from 6 to 75 mm,
with an average diameter of 25.9 mm.
All procedures were performed under ultrasound guidance for hepatic lesionsand CT guidance for lung lesions.
We considered follow up period starting from the diagnosis of metastatic disease (considering RFA or MWA...
Results
The periprocedural mortality was nil.
A single adverse event related to the procedure occurred (6,2% of patients,
3,1% of metastases),
classified as major complication.
Particularly,
it consisted of an intrahepatic haematoma (caused by a hepatic pseudoaneurysm,
cauterized with a re-insertion of the electrode-needle),
followed by a right hemothorax and finally drained under ultrasound guidance.
We were not able to get staging CT after RFA in 1/16 patients (2/32 metastases),
so we considered in our analysis 30 lesions:technique effectiveness after one or eventually two (considered part...
Conclusion
The ablation therapy seems to produce satisfying results in terms of local control as testimonied by a LTP rate of 27% in 46 months of mean follow up period,
affecting for the better part lesions beyond the therapy limits of ablation procedure (> 30 mm).
Considering the limited options for these patients and the relatively safety of ablation therapy it is plausible to propose this treatment in these settings.
Ablation therapy appears to be a feasible procedure,
with satisfying results on local control,
our intent...
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