Palliative external-beam radiotherapy in recurrent ovarian carcinoma.

Abstract

e15534 Background: Up to 80% of patients with advanced ovarian cancer will recur following first-line platinum based chemotherapy. Palliation of focal lesions is often needed to alleviate symptoms. Response rate to second and third-line chemotherapy remain disappointing. The study aim was to characterise the patient population referred for palliative radiotherapy for advanced and recurrent ovarian carcinoma and to assess the effectiveness of radiotherapy in this population. Methods: We retrospectively reviewed the medical records of 94 patients with advanced recurrent ovarian carcinoma referred for palliative radiotherapy between March 1994 and July 2011. The median age of the patients was 62 years (range 33 to 85). One to 16 cycles of a platinum-based chemotherapy regimen were delivered before irradiation (median = 7 cycles). The indications for palliative treatment were: pain (n = 41), mass (n = 32), brain metastases (n = 19), vaginal bleeding (n = 9), rectal bleeding (n = 4), shortness of breath (n = 3), tenesmus (n = 2), skin ulceration (n = 2) and jaundice (n = 1). Some patients received treatment for more than one indication. Sites irradiated included the pelvis (n = 44), brain (n = 19), abdomen (n = 10), bone (n = 5), supraclavicular fossae (n = 4), groins (n = 3), chest (n = 3) and other (n = 6). The median radiotherapy dose was 20 Gy (range: 6 – 50 Gy). The median fraction size was 4 Gy (range: 1.8 – 8 Gy). Results: The overall response rate was 61.7%. Complete palliative response was achieved in 17% of the patients. 27.6% of patients suffered progressive disease during treatment. 10.7% had stable disease. The median duration of palliation was 6 months and closely approximated their survival. The treatment was very well tolerated. Grade 1 or 2 diarrhoea and nausea were the main side effects. Conclusions: External-beam radiotherapy can provide effective and durable palliation of symptoms in patients with recurrent platinum-resistant ovarian carcinoma. The results from palliative radiotherapy are comparable to the published series using second and third-line chemotherapy in the treatment of recurrent focally symptomatic ovarian cancer.