STAGE-III OVARIAN-CARCINOMA - AN ANALYSIS OF TREATMENT RESULTS AND COMPLICATIONS FOLLOWING HYPERFRACTIONATED ABDOMINOPELVIC IRRADIATION FORSALVAGE

Purpose: Patients with persistent disease found at laparotomy followin g platinum-based chemotherapy for Stage III ovarian carcinoma have a r emote chance of cure with second-line chemotherapy or conventional rad iotherapy. To decrease relapse rates and improve tolerance, we have us ed twice-daily radiotherapy in 28 such patients. Methods and Materials : Twenty-eight patients with Stage III epithelial ovarian carcinoma we re treated with curative intent at the University of Florida with hype rfractionated, continuous-course radiotherapy for persistent disease a t laparotomy after administration of platinum-based chemotherapy. All patients received .8 Gy per fraction, twice daily, to a mean total dos e of 30.2 Gy to the whole abdomen and pelvis; 20 patients had addition al radiotherapy to the pelvis (mean, 14.54 Gy). All patients had under gone two to four (mean, 2.6) laparotomies for ovarian carcinoma and ha d received 6-28 (mean, 12) cycles of chemotherapy before irradiation. Results: With a 2-year minimum follow-up, survival rates at 1, 2, and 5 years were as follows: absolute survival, 79%, 50%, 21%; relapse-fre e survival, 52%, 36%, 19%. For the 11 patients with no evidence of gro ss residual disease after the second-look laparotomy, the absolute sur vival rates were 100%, 73%, and 27%. This was superior to the rates of 65%, 34%, and 18% for the 17 patients who had gross residual disease. Only two patients required treatment breaks. Four patients required s urgical intervention for small-bowel obstruction, which in two cases r evealed recurrent disease. Two patients died of treatment-related comp lications. Twenty-two of 23 failures occurred in the abdomen and/or pe lvis. Conclusion: Although most patients eventually relapse, a small p ercentage have had a prolonged disease-free interval. Since treatment was relatively well tolerated, escalation of the dose of hyperfraction ated abdominopelvic irradiation is being investigated.