The prognostic significance of peritoneal seeding and size of postsurgicalresidual in patients with stage III epithelial ovarian cancer treated withsurgery, chemotherapy, and high-dose radiotherapy

Objective. The aim of this study was to retrospectively analyze the prognos tic importance of age, histologic type and grade, ascites, lymph node statu s, size and type of postoperative residual disease, and radiation dose on d isease-specific (DSS) and progression-free survival (PFS) in stage III epit helial ovarian cancer patients who had been treated with radical surgery, p ostoperative chemotherapy, and high-dose radiotherapy. Methods. Consolidation radiotherapy including whole abdominal radiation, pe lvic, and upper abdominal boosts was employed in 46 patients who showed no evidence of residual or progressive disease after completion of multiagent chemotherapy. The median follow-up for all patients was 36 months and 103 m onths for patients at risk. The prognostic impact of pretreatment and treat ment parameters on DSS and PFS was tested in univariate and multivariate an alyses. Results, The 5-year DSS and PFS rates for all patients were 38 and 33%, and for patients with 0-less than or equal to 2 cm residual tumor 65 and 61%, respectively, In univariate analysis, initial peritoneal seeding (both: P = 0.02), ascites (P = 0.03; 0.01), size of residual (0-less than or equal to 2 cm vs >2 cm), and residual miliary subdiaphragmatic (MDS) and localized peritoneal seeding (LPS) in the upper abdomen (P = 0.0002; 0.0003) were sig nificantly correlated with DSS and PFS. Dose of radiation (less than or equ al to 30 vs >30 Gy) correlated with DSS only (P = 0.02). In multivariate an alysis size of residual disease (0-less than or equal to 2 cm vs >2 cm and/ or MDS or LPS) remained the only independent prognostic factor for DSS and PFS (both; P = 0.001). Conclusion, Patients with localized peritoneal seeding who were rendered fr ee of disease elsewhere had an outcome equally poor as that of patients wit h gross residuals (>2 cm) in the upper abdomen. If our findings can be conf irmed, attempted resection of all localized seeding in patients who are oth erwise cytoreducible to no or minimal residual disease may be considered in combination with Taxol-containing regimens as are now being utilized for p atients with gross disease. (C) 1999 Academic Press.