Trial Information

International Pediatric Adrenocortical Tumor Registry

Adrenocortical tumors (ACT) are very rare in children and teenagers. Of all the new cases of
cancer diagnosed each year in the United States and Europe in patients younger than 20 years
old, only about 0.2% are ACT. Studies from several laboratories including St. Jude
Children's Research Hospital have revealed that the majority of children with ACT,
particularly those younger than 4 years of age, have constitutional P53 mutations. Some
mutations, as exemplified by the R337H P53 germline mutation, in which the function of the
mutant protein is relatively preserved, the history of cancer in the carriers and their
families is relatively unremarkable. In other cases, the P53 mutated gene encodes a
functionally-impaired protein that predicts for a pervasive history of familial cancer
(Li-Fraumeni syndrome). Therefore, these observations have implications for genetic
counseling of families with childhood ACT and underscore the importance of
genotype-phenotype correlations in familial cancer syndromes.

The creation of a specific rare tumor registry provides a mechanism to collect information
that cannot be gathered in a single institution. The analysis of the registry data would
permit an overview of the clinical, epidemiological, current treatment standards, and
survival data of these patients and thus create opportunities for research. It also may
facilitate the development of treatment consensus among investigators who register their
patients and help to design future studies. Moreover, the combined COG and IPACTR studies
are expected to provide meaningful insight into the biology of ACT, including clinical
phenotype/genotype relationships, treatment outcome and long-term follow-up data in subjects
with this rare tumor. Finally, it would provide data on the long-term consequences of
exposure to tumor-secreted androgens (found in more than 80% of the pediatric cases) on
children's growth and development.