S. Reddy et al., SALVAGE WHOLE ABDOMEN RADIATION-THERAPY - ITS ROLE IN OVARIAN-CANCER, International journal of radiation oncology, biology, physics, 27(4), 1993, pp. 879-884
Citations number
31
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
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.