Whole abdominal radiotherapy following second-look laparotomy for ovarian carcinoma

Aim. The safety and efficacy of whole abdominal radiotherapy was evaluated as salvage or consolidation treatment for ovarian cancer patients treated w ith primary surgery and chemotherapy, followed by second-look laparotomy (S LL). Overall survival and acute and late toxicity of treated patients were assessed. Methods. Patients were recruited between April 1981 and June 1994, All pati ents had SLL performed at Royal Prince Alfred Hospital after completion of primary chemotherapy. Data collected included demographic details, diagnosi s, tumor stage, histology, grade, adjuvant chemotherapy, and radiotherapy. Radiation dose and fractionation, held size, boost volume and dose, failure to complete treatment and treatment interruptions, renal dose, and acute a nd late toxicity were recorded. Results. Fifty-one patients were evaluated; the median age was 51 years. Me dian follow-up for patients still alive was 62 months. Prior to 1988, chemo therapy comprised oral chlorambucil, with or without cisplatin (n = 25), wh ile after this date all patients (n = 26) received primary cisplatin-based therapy. A radiation dose of 22.5 Gy over 22 fractions was planned to the w hole abdomen followed by a pelvic boost of 22 Gy in 11 fractions. Radiother apy was completed in 37 (73%) patients. Treatment interruptions were necess ary in 12 (24%) patients.. Thrombocytopenia, neutropenia, nausea, vomiting, and diarrhea were the main causes of incomplete or interrupted treatment, Late bowel toxicity was seen in 6 (12%) patients, 2 of whom required laparo tomy to relieve obstruction. There were no treatment-related deaths. Seven of the 51 patients are alive and free of disease, 2 died from other causes, and 2 are alive with evidence of recurrent or progressive disease. Mean fo llow-up time far surviving patients is 78.5 months. Overall survival at 2, 5, and 10 years was 65, 27, and 10%, respectively. Residual disease after p rimary surgery, smaller preirradiation tumor residuum, and completion of ra diotherapy were independently associated with improved overall survival. Conclusion. In this poor-prognosis group of patients, a combined approach o f surgery, chemotherapy, and radiotherapy, while associated with acceptable toxicity, may not afford a prolongation of survival. (C) 1999 Academic Pre ss.