Intensive multimodality therapy including paclitaxel and reduced-intensity allogeneic hematopoietic stem cell transplantation in the treatment of adrenal cancer with multiple metastases |
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Authors: | Osamu Imataki Atsushi Makimoto Rie Kojima Michiyo Sakiyama Ako Hosono Yoichi Takaue |
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Institution: | (1) Hematopoietic Stem Cell Transplantation Unit and Pediatric Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan |
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Abstract: | Adrenocortical carcinoma is a rare malignancy in adolescents and young adults. The prognosis of unresectable/metastatic adrenocortical
carcinoma remains very poor because the rarity of the tumor has made it difficult to establish treatment guidelines, and diagnosis
and the resultant treatment can be greatly delayed. We treated a 24-year-old woman who was diagnosed with adrenocortical carcinoma
of the right adrenal gland which extended to the inferior vena cava. Although she underwent surgical resection of the extensive
tumor as the primary treatment, the disease recurred in the lung and liver as multiple metastases shortly after surgery. She
received intensive multimodality therapy, including chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP regimen),
embolization of the feeding arteries, and proton irradiation for the liver mass. Finally, she underwent reduced-intensity
allogeneic hematopoietic stem cell transplantation from an HLA 1-locus-mismatched sibling donor. A prolonged survival of 39
months after the onset of the disease was achieved. Although this experience is limited, we suggest that TIP chemotherapy
was effective for adrenocortical carcinoma, and a graft-versus-tumor effect after reduced-intensity stem cell transplantation
may have contributed to the prolonged survival. |
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Keywords: | Allogeneic stem cell transplantation (allo-SCT) Reduced-intensity stem cell transplantation (RIST) Adrenocortical carcinoma (ACC) Graft-versus-tumor (GVT) reaction Graft-versus-host disease (GVHD) |
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