S1251
Clinical - Urology
ESTRO 2026
Memorial Centre, HBNI, Mumbai, India. 4 Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
Purpose/Objective: Adrenocortical carcinoma (ACC) with high-risk features has a high rate of disease recurrence despite complete surgical (R0) resection. Adjuvant radiotherapy (RT) can be an effective treatment to improve outcomes, but the supportive evidence is sparse. This systematic review and meta-analysis was undertaken to assess the efficacy and safety of adjuvant RT after radical surgery for patients with non-metastatic ACC Material/Methods: A systematic literature search was conducted in Medline via PubMed on 1st October 2025 in accordance with PRISMA guidelines. Studies which satisfied the PICO framework and comparing adjuvant RT following surgery versus surgery alone in patients with non-metastatic ACC were included. Studies reporting on palliative treatments, using SEER/NCDB data, incomplete data, case reports, reviews, editorials, meta-analyses and non-English publications were excluded. Two reviewers independently screened each study and extracted data. The quality of each study was assessed using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Outcomes analysed were local recurrence-free survival (LRFS), recurrence-free survival (RFS) and overall survival (OS). Adverse events reported were descriptively summarised. Analysis performed using RevMan v5.4, and pooled hazard ratios (HR) for survival outcomes were calculated using the random-effects model (DerSimonian-Laird), and heterogeneity was assessed using I2 statistic. The review protocol was prospectively registered in the INPLASY database (INPLASY202540090). Results: A total of eight retrospective studies comprising 414 patients were included in the review (Figure 1). Adjuvant RT was considered for patients with high-risk features such as positive surgical margin (R1), incomplete resection (R2), Ki-67 >10%, rupture of capsule/tumour spillage, large tumour size and high grade. Overall, about 35% patients had functional tumours. Among the total cohort, 66% underwent R0 resection. About half of the study cohort (48%) received adjuvant RT after surgery. RT dose ranged from median 45 to 60 Gy, typically delivered in 1.8 to 2 Gy per fraction. Mitotane usage was inconsistent (2%- 77%) across studies. Median follow-up ranged from 22 to 62 months. On meta-analysis, adjuvant RT was associated with significantly improved LRFS [pooled HR 0.37 (95% CI 0.24-0.58), p= <0.0001], RFS [pooled HR 0.69 (0.49-0.97), p= 0.03] and OS [pooled HR 0.56 (0.36-0.86), p= 0.009]. Adverse events reported with adjuvant RT were mostly mild gastrointestinal symptoms, with minimal grade 3 events.
Conclusion: For ACC with high-risk features after radical resection, adjuvant RT significantly improves disease control and overall survival, with limited adverse effects. Adjuvant RT should be integrated into the multidisciplinary management of ACC. Keywords: Adrenocortical Carcinoma, Adjuvant Radiotherapy
Mini-Oral 3159
Daily Adaptive RadioTherapy in Postoperative HypofrActionated Salvage radiothERapy for prostate cancer patients (DART-PHASER): preliminary results Luca Nicosia 1 , Riccardo Filippo Borgese 1 , Margherita Corsi 2 , Andrea Gaetano Allegra 1 , Nicola Bianchi 1 , Chiara De-Colle 1 , Antonio De Simone 1 , Niccolò Giaj- Levra 1 , Gloria Guardia 3 , Davide Gurrera 1 , Stefania Naccarato 1 , Carolina Orsatti 1 , Edoardo Pastorello 1 , Francesco Ricchetti 1 , Michele Rigo 1 , Andrea Romei 1 ,
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