Surgery and Heated Intraperitoneal Chemotherapy for Adrenocortical Carcinoma

Inclusion Criteria

• •Histologically proven ACC with the majority of disease confined to the peritoneal cavity and resectable or amenable to radiofrequency ablation
• •Disease evaluable by CT or Positron Emission Tomography (PET) imaging
• •All disease should be deemed resectable based on imaging studies e.g.:
• •* Hepatic metastases (unilateral or bilateral less than or equal to 5 lesions, less than or equal to 15 cm total diameter)
• •* Note: Hepatic lesions must be amenable to complete resection
• •* Primary peritoneal metastases (small disease load less than or equal to P2 disease) without massive ascites or intestinal obstruction
• •* Lung metastases (less than or equal to 3 unilateral/bilateral, 9 cm total diameter)
• •* Note: lung lesions must be amenable to complete resection
• •* Note: Patients with both pulmonary and hepatic metastases will be enrolled at the discretion of the PI
• •* Note: In situations where resection to Completeness of Cytoreduction Score (CC) 0 or 1 is uncertain, patients may undergo diagnostic laparoscopy prior to enrollment to determine feasibility of resection.
• •Greater than or equal to 18 years of age
• •Able to understand and sign the Informed Consent Document
• •Clinical performance status of Eastern Cooperative Oncology Group (ECOG) less than or equal to 2
• •Life expectancy of greater than three months
• •Patients of both genders must be willing to practice birth control during and for four months after receiving chemotherapy
• •Hematology:
• •* Absolute neutrophil count greater than 1500/mm\^3 without the support of Filgrastim.
• •* Platelet count greater than 75,000/mm\^3.
• •* Hemoglobin greater than 8.0 g/dl.
• •Chemistry:
• •* Serum creatinine less than or equal to 1.5 mg/dl unless the measured creatinine clearance is greater than 60 mL/min/1.73 m2
• •* serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) within 5 times the upper limit of normal and a total serum bilirubin of less than 3 times the upper limit of normal, both of which define the upper limit of grade 2 treatment related toxicities.
• •* Prothrombin time (PT) within 2 seconds of the upper limit of normal (INR less than or equal to 1.8)
• •Recovered from any toxicity to grade 2 or less from all prior chemotherapy, immunotherapy or radiotherapy and be at least 30 days past the date of their last treatment with the exception of mitotane which may be continued.
• •Able to understand their disease and the exploratory nature of combining surgery and HIPEC for this histology.
• •\- Significant chronic obstructive pulmonary disease (COPD) or other chronic pulmonary restrictive disease with pulmonary function test (PFT) indicating an forced expiratory volume at one second (FEV1) less than 50% or a diffusing capacity of lung for carbon monoxide (DLCO) less than 40% predicted for age.
• •Grade 2 or greater neuropathy
• •Women of child-bearing potential who are pregnant or breastfeeding because of the potentially dangerous effects of the chemotherapy on the fetus or infant.
• •Brain metastases or a history of brain metastases
• •Childs B or C cirrhosis
• •Evidence of severe portal hypertension by history, endoscopy, or radiologic studies
• •Note: Any diagnosis of portal hypertension or clinical stigmata of such including but not limited to gastric or esophageal varices, umbilical vein varices or telangiectasias.
• •Weight less than 30 kg
• •Active systemic infections, coagulation disorders or other major medical illnesses of the cardiovascular, respiratory or immune system, myocardial infarction, cardiac arrhythmias, obstructive or restrictive pulmonary disease