Effective palliative radiation therapy in advanced and recurrent ovarian carcinoma

Purpose: To retrospectively review our experience using radiation therapy a s a palliative treatment in ovarian carcinoma. Methods and Materials: Eighty patients who received radiation therapy for o varian carcinoma between 1983 and 1998 were reviewed. The indications for r adiation therapy, radiation therapy techniques, details, tolerance, and res ponse were recorded. A complete response required complete resolution of th e patient's symptoms, radiographic findings, palpable mass, or CA-125 level . A partial response required at least 50% resolution of these parameters. The actuarial survival rates from initial diagnosis and from the completion of radiation therapy were calculated. Results: The median age of the patients was 67 years (range 26 to 90 years) . A median of one laparotomy was performed before irradiation. Zero to 20 c ycles of a platinum-based chemotherapy regimen were delivered before irradi ation (median = 6 cycles). The reasons for palliative treatment were: pain (n = 22), mass (n = 23), obstruction of ureter, rectum, esophagus, or stoma ch (n = 12), a positive second-look laparotomy (n = 9), ascites (n = 8), va ginal bleeding (n = 6), rectal bleeding (n = 1), lymphedema (n = 3), skin i nvolvement (n = 1), or brain metastases with symptoms (n = 11). Some patien ts received treatment for more than one indication. Treatment was directed to the abdomen or pelvis in 64 patients, to the brain in 11, and to other s ites in 5. The overall response rate was 73%. Twenty-eight percent of the p atients experienced a complete response of their symptoms, palpable mass, a nd/or CA-125 level. Forty-five percent had a partial response. Only 11% suf fered progressive disease during therapy that required discontinuation of t he treatment. Sixteen percent had stable disease. The duration of the respo nses and stable disease lasted until death except in 10 patients who experi enced recurrence of their symptoms between 1 and 21 months (median = 9 mont hs). The 1-, 2-, 3-, and 5-year actuarial survival rates from diagnosis wer e 89%, 73%, 42%, and 33%, respectively. The survival rates calculated from the completion of radiotherapy were 39%, 27%, 13%, and 10%, respectively. F ive percent of patients experienced Grade 3 diarrhea, vomiting, myelosuppre ssion, or fatigue. Fourteen percent of patients experienced Grade 1 or 2 di arrhea, 19% experienced Grade I or 2 nausea and vomiting, and 11% had Grade 1 or 2 myelosuppression. Conclusions: In this series of radiation therapy for advanced ovarian carci noma, the response, survival, and tolerance rates compare favorably to thos e reported for current second- and third-line chemotherapy regimens. Cooper ative groups should consider evaluating prospectively the use of radiation therapy before nonplatinum and/or nonpaclitaxel chemotherapy in these patie nts. (C) 2001 Elsevier Science Inc.