Abstract
Background: The examination of the use of whole abdomen irradiation open field technique in optimally debulked patients with no residual disease with epithelial ovarian cancer (OC). Methods: Between 1993 and 2007, 20 patients with optimally cytoreduced epithelial OC were treated with WAI. The stage distribution was stage I in 15 patients, stage II in 1, and stage III in 4. The grade distribution was grade 1 in 10 patients, grade 2 in 4, and grade 3 in 6. WAI consisted of 30 Gy, delivered in daily fractions, mainly of 1.5 Gy (95%), 5 days/weekly, in 14 patients. After abdominal irradiation, in 75% of the patients a pelvic boost, and in 7 a boost to other risk sites was given to reach 45 - 50 Gy. Nine patients received platinum based chemotherapy (CT). Median follow-up was 7.96 years. Results: The overall survival (OS) rate was 82% and 70% at 5 and 10 years. A tendency to better survival was found in patients with age ? 40 than in those with > 40 years (100%:100% vs. 68%:51%; p=0.03). Patients with grade 1-2 tumors had significantly better 5- and 10-year survival rate than those with grade 3 tumors (100%:100% vs. 40%:20%; p<0.00). The 5- and 10-year OS for the patients 'with' and 'without' a pelvic boost turned to be in favor of the patients 'with' the boost (91%:91% vs. 60%:40%; p=0.02). In 15 patients (75%) RT was transiently interrupted because of acute gastrointestinal and hematological toxicity. Neither grade 4 acute complications nor was mortality observed. Late gastrointestinal effect developed in 1 patient, presented with grade 4 complications. The development of second primary malignancy was not observed during the follow-up period. Conclusion: WAI achieves a quite favorable 5- and 10-year survival rate with an acceptable risk of acute and late side effects in properly selected patients with epithelial OC.
Highlights
Ovarian cancer (OC) is a highly lethal disease and is the fifth cause of cancer death among Bulgarian women [1]
Whole abdomen irradiation (WAI) as radiotherapy (RT) technique that targets the anatomic sites at highest risk for dissemination of epithelial OC has long been recognized as an effective adjuvant treatment for women with early-stage optimally debulked disease [6]
Because of the nature of the study, CT was not given according to the program or protocol but according to the physician's preferences
Summary
Ovarian cancer (OC) is a highly lethal disease and is the fifth cause of cancer death among Bulgarian women [1]. It has the highest mortality of all gynecologic cancers with an annual mortality rate of 10.8/100,000 women [1]. Multiple single-institution studies and randomized trials exploring WAI, reported 5- and even 10-year survival rates reaching up to 70% [8,9,10]. Despite these publications the controversy on the role of WAI remains. The contemporary chemotherapeutic schemes require further research and development of new therapeutic approaches, with radiotherapy as a part of the combined modality approach and as a salvage therapy for patients with small volume persistent disease after primary cytoreductive surgery and chemotherapy [7,8,9,10]
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