Adrenalectomy for Disseminated Mammary Carcinoma

Abstract

191 patients with advanced breast cancer were subjected to bilateral adrenalectomy at the National Cancer Institute of Milan during the 13 years 1955 to 1967. The only criterion for selection was that patients should be acceptable surgical risks. 18 patients died in the 30 days following surgery, giving a mortality rate of 9.4%. Out of the 157 patients available for statistical evaluation, 66 (42%) responded favourably to adrenalectomy. Remissions from 6 months to 10 years were obtained, with a median duration of 18 months. The responders survived from 1 to 11 years, with a median of about 30 months. In 7 patients regression lasted more than 5 years and 10 patients survived longer. 19 patients (12 %) had subjective improvement with arrest of the disease for a median duration of 8 months and had a median survival of about 16 months. 72 patients did not respond to surgery, and they survived only about 5 months. In over 40 % of the patients subjected to both bilateral oophorectomy and adrenalectomy disease regressed only 22 % of patients subjected to bilateral oophorectomy, right adrenalectomy and implantation of the left adrenal in the spleen responded to treatment. Bilateral adrenalectomy alone, in patients post-menopausal more than 5 years, yielded the same results as combined oophorectomy and adrenalectomy. In pre-menopausal patients the regression rate and the length of remission were the same whether oophorectomy preceded adrenalectomy or whether the two operations were performed at the same time. Prognosis was not influenced by the physiological age of patients, though patients under 35 years of age responded less frequently to treatment. The best results were achieved in patients with a free interval longer than two years, in whom the disease was confined to soft tissues, bone and lung; in patients who responded well to previous oophorectomy or to hormonal treatment and, in post-menopausal patients, when a high cytological index was found in the vaginal smear. The histological pattern of the primary mammary carcinoma, the localisation of the disease to the ovaries or to the andrenals, the presence of cortical stromal hyperplasia in the ovary and the excretion of estrogens did not influence prognosis. Bilateral adrenalectomy and oophorectomy, like surgical hypophysectomy, is the most helpful treatment for disseminated mammary carcinoma and the sooner it is undertaken the greater is its efficacy.