Radiation after surgery may keep rare adrenal cancer at bay

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * age ≥ 18 years and ≤ 75 years. * ECOG performance status score ≤ 1, with an expected survival period ≥ 6 months. * Completion of radical resection for adrenocortical carcinoma (ACC) with curative intent. * Postoperative pathological diagnosis of adrenocortical carcinoma. * Pathological stage is localized ACC: ENSAT stage 1-3; where ENSAT stage 3 is defined as any T stage (T1-4) with regional lymph node positivity, or tumor invasion into surrounding tissues/organs or the renal vein/inferior vena cava, but without distant metastasis. * High-risk factors: Ki-67 index \>10%, ENSAT stage 3, positive resection margin, high pathological grade; the presence of any one of these factors qualifies. * Postoperative imaging review prior to radiotherapy shows no evidence of residual or metastatic disease. Exclusion Criteria: * ENSAT Stage 4 adrenocortical carcinoma. * Performance status: Karnofsky Performance Status (KPS) score ≤ 70 or Zubrod score \> 2. * Prior radiotherapy to the abdomen or pelvis. * Insufficient function of major organs (heart, lung, liver, kidney, bone marrow hematopoiesis) precluding tolerance to radiotherapy. * Pregnant or lactating women, and subjects of childbearing potential unwilling to use contraception. * Patients with psychiatric disorders, history of alcoholism or substance abuse, or those unable to provide informed consent. * Other conditions deemed by the investigator to make the subject unsuitable for participation in this trial, including but not limited to: severe illnesses requiring immediate intervention (including psychiatric disorders), severely abnormal laboratory results, or other social or familial high-risk factors. * Patients with other concurrent primary cancers; or patients diagnosed with another primary malignancy within the 5 years prior to the study (except for adequately treated carcinoma in situ of the cervix, or skin cancers such as basal cell carcinoma, squamous cell carcinoma, or non-melanomatous skin cancer).