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Adrenocortical Carcinoma — SCE Medical Oncology MCQ

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HardCancer of Unknown PrimaryAdrenocortical CarcinomaSCE Medical Oncology

After R0 resection of stage III adrenocortical carcinoma, Ki-67 is 25% and there is no metastasis. Which adjuvant strategy is recommended for this high-recurrence-risk setting?

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Correct answer: E — Start mitotane, aiming for at least two years and generally no more than five years if tolerated

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · C = shown as D · A = shown as E

A is correct. Stage III disease and Ki-67 25% define high recurrence risk, for which European endocrine-oncology guidance suggests adjuvant mitotane after radical resection. Treatment is commonly continued for at least two years and not beyond five years, with plasma-level, adrenal-replacement, hepatic, neurological and endocrine monitoring. Radiotherapy can be considered selectively for local-risk features but is not a systemic substitute; pembrolizumab and sunitinib lack established adjuvant roles; and R0 resection does not erase the metastatic and local relapse risk. Cytotoxic chemotherapy is individualised in exceptionally high-risk cases rather than automatically appended to every mitotane course.

Reference: European Society of Endocrinology adrenocortical carcinoma guideline: https://academic.oup.com/ejendo/article/179/4/G1/6655445