SALVAGE WHOLE ABDOMEN RADIATION-THERAPY - ITS ROLE IN OVARIAN-CANCER

Purpose: In spite of high initial response rates, many patients with e pithelial ovarian carcinoma eventually fail their primary treatment. F urther treatment with second-line regimens has been ineffective in pro ducing durable responses. Thus, whole abdomen radiation therapy was ev aluated as a salvage therapeutic modality as to its feasibility, effic acy, and toxicity. Methods and Materials: Between June 1983 and June 1 990, 44 patients who failed one or more chemotherapeutic regimens were treated with whole abdomen radiation therapy. Forty patients had epit helial carcinoma of the ovary and the remaining had primary adenocarci noma of the peritoneal cavity. Radiation was delivered with an open-fi eld technique and 2500 cGy were planned to the whole abdomen, with a b oost when indicated. Prior to radiation, the amount of residual diseas e after debulking was noted to be microscopic in one-half of the patie nts and macroscopic in the other half. Pelvis alone was the site of re sidual disease in 14 patients, and upper abdominal involvement was fou nd in 30. Results: Five patients (11%) were unable to complete the pla nned therapy secondary to acute toxicity. The 4-year actuarial surviva l and recurrence-free survival rates for the entire group were 23% and 22%, respectively. The survival and recurrence-free survival rates fo r the group with microscopic residual disease at 37% and 42% were sign ificantly better than those for the patients with macroscopic residual disease at 9% and 5% (p < 0.005; p < 0.001) at 4 years, respectively. Patients with disease limited to pelvis only had a recurrence-free su rvival of 56% compared to 0% when the upper abdomen was involved (p < 0.005). The abdomino-pelvic cavity was the first site of recurrence in 28 of 31 patients in whom the site of recurrence could be determined. Eight patients (18%) experienced bowel complications, of whom five ne eded surgical intervention. Conclusions: Whole abdomen radiation thera py with a pelvic boost is feasible with acceptable acute and late toxi city. It is effective in patients with minimal residual disease.