Cytoreductive Surgery and Heated Cisplatin in Treating Patients with Adrenocortical Cancer

Inclusion Criteria

• Histologically proven adrenocortical carcinoma (ACC) with the majority of disease confined to the peritoneal cavity and resectable or amenable to radiofrequency ablation; or disease that in the opinion of the investigators can be managed medically or surgically and does not present an immediate threat to the patient’s life
• Disease evaluable by computed tomography (CT) or positron emission tomography (PET) imaging
• All disease should be deemed resectable based on imaging studies e.g.: * Hepatic metastases (unilateral or bilateral =< 5 lesions, =< 15 cm total diameter) ** Note: Hepatic lesions must be amenable to complete resection * Primary peritoneal metastases (small disease load =< P2 disease) without intestinal obstruction * Lung metastases (=< 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 principal investigator (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) =< 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
• 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
• Serum creatinine less than or equal to 1.5 mg/dl unless the measured creatinine clearance is greater than 60 mL/min/1.73 m^2
• 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 (institutional normal ratio [INR] =< 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

Exclusion Criteria

• Concomitant medical problems that would place the patient at unacceptable risk for a major surgical procedure
• Hydronephrosis or biliary obstruction as these are usually signs of unresectability
• History of congestive heart failure and/or an left ventricular ejection fraction (LVEF) < 40%; echocardiography performed only as indicated based on clinical signs or symptoms
• Significant chronic obstructive pulmonary disease (COPD) or other chronic pulmonary restrictive disease with pulmonary function tests (PFT’s) indicating an forced expiratory volume in 1 second (FEV1) less than 50% or a carbon monoxide diffusing capability test (DLCO) less than 40% predicted for age; PFTs performed only as indicated based on clinical signs or symptoms
• 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 < 30 kg
• Active systemic infections, coagulation disorders or other major medical illnesses of the cardiovascular, respiratory or immune system, myocardial infarction within the last 6 months, life threatening cardiac arrhythmias, obstructive or restrictive pulmonary disease