Whole Abdominal Irradiation Research Articles

Adjuvant whole-abdominal radiation therapy in uterine papillary serous carcinoma

Nine patients from 34 to 74 years of age (median, 67 years of age) with uterine papillary serous carcinoma (UPSC) were treated with whole-abdominal radiation therapy (WART) on an adjuvant basis after cytoreductive surgery. All patients were treated with megavoltage photons to an abdominopelvic field to a median dose of 2500 cGy, with continued treatment to a whole pelvic field to a median dose of 4500 cGy. Three patients received additional boost to the vaginal apex. Follow-up time ranged from 6 to 31 months (median, 25 months) after completion of WART. Six patients had recurrent disease at 5 to 20 months (median, 7.5 months). Four of these patients died of their disease during the follow-up period. Three of six patients in whom treatment failed had disease at the vaginal apex. None of these patients received boost radiation therapy to that site. In contrast, two of three patients remaining disease free were treated with additional vaginal apex irradiation. Based on these results, the authors do not routinely recommend WART for adjuvant treatment of UPSC. They do, however, recommend vaginal apex irradiation for these patients.

Whole-abdominal irradiation for the management of gastrointestinal and abdominal manifestations of agnogenic myeloid metaplasia

A patient with a long-standing history of agnogenic myeloid metaplasia developed weight loss and ascites secondary to gastric/small bowel infiltration and peritoneal implants of myeloid tissue. Moderate doses of radiation were very effective in controlling her gastrointestinal symptoms. In contrast to previous reports, clinical improvement after irradiation was a slow, gradual process, requiring 5 months for complete resolution of the patient's ascites. Hematologic suppression may be profound and careful attention to the rate of change in leukocyte and platelet counts is necessary to avoid severe toxicity.

Whole abdomen radiation therapy after a short chemotherapy course and second-look laparotomy in advanced ovarian cancer

From April 1983 through December 1989, 42 consecutive patients with diagnosis of epithelial ovarian carcinoma were initially managed by aggressive surgery and three courses of endoperitoneal cis-platinum-based chemotherapy followed by an alternating combination chemotherapy and second-look laparotomy. Patients with residual tumor ⩽2 cm subsequently received whole abdominal radiation therapy (WAR). Twenty-eight patients (42% with no residual disease, 21% with microscopic disease, and 36% with residual disease <2 cm) were eligible for WAR. WAR was delivered using an open-field technique up to 22 Gy in 20 fractions followed by a pelvic boost of 18 Gy in 10 fractions. The kidneys were shielded posteriorly at 1100 cGy; hepatic shields were not added. One patient did not complete WAR for lung metastases after 5 radiotherapy fractions. The complete treatment program lasted 8 months (range, 6.8–11). The median follow-up of the 28 patients entered into the study was 50 months. Eight patients are alive and disease-free at 5 years. The overall and disease-free survival rates at 5 years are 45 and 30%, respectively. All but 2 patients relapsed within the abdominopelvic cavity and 3 developed brain metastases. Toxic effects, during WAR, required treatment interruption in all but 4 patients: 3 developed a small bowel obstruction requiring surgery and 1 died of surgical complications in complete remission. The poor disease-free survival and the severe toxicity encountered have been valid indications that WAR should be discontinued as a treatment modality in advanced ovarian cancer at our department.

Concomitant whole-abdominal radiation and intraperitoneal chemotherapy in advanced ovarian carcinoma. A pilot study

Because the use of cisplatin-based chemotherapy for ovarian carcinoma has not significantly improved 5-year survival rates compared with either whole-abdominal radiation (WAR) or single-agent chemotherapy, a pilot study was begun to assess the feasibility of concomitant radiation and chemotherapy. Eleven previously untreated patients with Stages III and IV ovarian carcinoma were treated concomitantly with 2000 cGy of WAR and intraperitoneal (IP) cisplatin followed by additional IP cisplatin after debulking surgery. Toxicity was moderate to severe. Sixty-four percent of patients had Grades 3 to 4 hematologic toxicity, and 36% required hospitalization for sepsis during WAR/IP cisplatin. Hematologic toxicity was less pronounced during IP cisplatin alone. All patients experienced moderate gastrointestinal toxicity. The average percentage of total body weight lost was 13.5%. Fifty-five percent of all patients demonstrated a complete clinical response to therapy, and patients with minimal postoperative residual disease fared better. One patient with persistent disease had acute nonlymphocytic leukemia (ANLL) 24 months after initial diagnosis. No patients with residual disease greater than 20 mm survived, while 50% of patients with less than 20 mm are clinically free of disease. Toxicity appears to be additive with the combination of WAR and IP cisplatin. Therapeutic efficacy was comparable with standard chemotherapy regimens, but no therapeutic or survival advantages were demonstrated with the use of this treatment protocol.

Consolidation Radiotherapy Following Carboplatin-Based Chemotherapy in Radically Operated Advanced Ovarian Cancer

Adjuvant chemoradiotherapy was administered to 26 patients with stage Ic-IV ovarian cancer after radical cytoreductive surgery. All patients received six cycles of carboplatin, epirubicin, and prednimustine and had no evidence of disease after completion of chemotherapy. They received whole-abdominal radiation and radiation to the retroperitoneal lymph nodes. Five (23%) of the patients were discontinued on this protocol because of myelosuppression, progressive disease, or withdrawal. One patient had a small bowel obstruction due to intraperitoneal adhesions. The survival of 10 Stage III ovarian cancer patients who received chemoradiotherapy and were evaluable for assessment of treatment efficacy was retrospectively compared with the survival of 11 Stage III patients who received chemotherapy only. At 36 months, a slight advantage of the chemoradiotherapy versus the chemotherapy-only group was observed (p = 0.11). These preliminary results suggest that adjuvant chemoradiotherapy may prolong the "no evidence of disease" interval of radically operated ovarian cancer patients. Toxicity is acceptable when second-look surgery is avoided and when subsequent radiotherapy is limited to patients with no clinical evidence of disease.

Whole-abdominal radiotherapy for patients with minimal residual epithelial ovarian cancer

Whole-abdominal radiotherapy for patients with minimal residual epithelial ovarian cancer

Salvage whole-abdominal irradiation following chemotherapy failure in epithelial ovarian carcinoma

International Journal of Gynecology & ObstetricsVolume 34, Issue 1 p. 94-94 Citations from the literature oncology Salvage whole-abdominal irradiation following chemotherapy failure in epithelial ovarian carcinoma DE Linstadt, Search for more papers by this authorJL Stern, Search for more papers by this authorJM Quivey, Search for more papers by this authorSA Leibel, Search for more papers by this authorCG Lacey, Search for more papers by this author DE Linstadt, Search for more papers by this authorJL Stern, Search for more papers by this authorJM Quivey, Search for more papers by this authorSA Leibel, Search for more papers by this authorCG Lacey, Search for more papers by this author First published: January 1991 https://doi.org/10.1016/0020-7292(91)90590-2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume34, Issue1January 1991Pages 94-94 RelatedInformation

Primary adjuvant whole abdominal irradiation in ovarian carcinoma

Eighty-four patients with an ovarian carcinoma Stage I–III received an adjuvant whole abdominal irradiation (WAI) with pelvic boost postoperatively. Surgery included a bilateral salpingo-oophorectomy, hysterectomy, and omentectomy in 59% of the patients; in 41% surgery was less radical. For the whole abdominal irradiation we used the moving-strip method on 43 patients. The open-field technique was used on the other patients. Median dose of WAI was 22.5 Gy and median pelvic dose was 45.5 Gy. After a median follow-up of 68.5 months, a 5-year survival rate of 64 ± 5.7% was determined, as well as a 5-year NED rate of 61.2 ± 5.7%. Five-year survival rate was 80.1 ± 7.4% in Stage I, 64.1 ± 9.7% in Stage II, and 35.4 ± 11.6% in Stage III. Five-year survival depended on tumor rest significantly. There was a trend to better prognosis when surgery was complete and grade was G 1 or G 2. The risk factor according to Dembo proved to be the most reliable prognostic factor: the 5-year survival rates were 75.0 ± 6.3% for patients with intermediate risk and 20.1 ± 10.4% for those with high risk ( p = 0.001). Side effects were generally well tolerated. We only saw one serious complication, a radiation-induced small bowel obstruction.

Prophylactic glutamine protects the intestinal mucosa from radiation injury

Glutamine may be an essential dietary component, especially for the support of intestinal mucosal growth and function. This study evaluated the effects of a glutamine-enriched elemental diet, administered before whole-abdominal radiation on gut glutamine metabolism, mucosal morphometrics, and bacterial translocation. Rats were randomized to receive a nutritionally complete elemental diet that was glutamine-enriched or glutamine-free for 4 days. The animals were then subjected to a single dose of 1000 cGy x-radiation to the abdomen. After irradiation, all animals received the glutamine-free diet. Four days later the animals underwent laparotomy for sampling of arterial and portal venous blood, culture of mesenteric lymph nodes, and removal of the small intestine for microscopic examination. There was no difference in arterial glutamine or gut glutamine extraction between the two groups, but body weight loss was significantly diminished in the glutamine-fed rats. Rats receiving the glutamine-enriched elemental diet before radiation had a significant increase in jejunal villous number, villous height, and number of metaphase mitoses per crypt. Scanning electron microscopy confirmed the presence of an intact gut epithelium in eight of eight rats receiving prophylactic glutamine compared to one of eight animals in the glutamine-free group. Three of eight rats fed glutamine had culture positive mesenteric lymph nodes compared with five of seven rats receiving the glutamine-free diet. Glutamine exerts a protective effect on the small bowel mucosa by supporting crypt cell proliferation effect on accelerate healing of the acutely radiated bowel.

Whole-abdominal radiotherapy for patients with minimal residual epithelial ovarian cancer

Sixteen patients with advanced epithelial ovarian cancer who were treated with cytoreductive surgery followed by multiagent chemotherapy were found to have residual tumor masses less than 2 cm in greatest diameter at reexploration and were treated with whole-abdominal radiation (19–31 Gy). Thirteen patients also received pelvic boosts to a total pelvic dose of 41–53.7 Gy. Radiotherapy was completed in all but 2 patients after treatment delays in 7 patients. Early treatment complications included myelosuppression in 11 patients, diarrhea in 3, and a self-limited small bowel obstruction in one. Delayed complications were severe and included 9 patients with radiation enterocolitis, 8 of whom required intestinal resection or diversion. One additional patient with radiation cystitis required instillation of formalin to control bleeding. Two patients are without evidence of disease 28 and 30 months following radiotherapy, while the remaining 14 patients have recurred after a median progression-free interval of 9 months (range 1–30 months). All patients who recurred failed within the treatment field and died of cancer after a median interval of 19 months following radiotherapy and 9 months after documentation of progression. These data suggest that few patients with persistent ovarian cancer following surgery and chemotherapy will be salvaged with radiotherapy.

Salvage whole-abdominal irradiation following chemotherapy failure in epithelial ovarian carcinoma

During the period 1977 to 1985, 12 patients with FIGO stage II and III epithelial ovarian carcinoma failed to achieve a pathologic complete response with chemotherapy and underwent salvage whole-abdominal irradiation (WAXRT). Six of these patients had gross residual disease present at the time of irradiation, and three (50%) were unable to complete the planned radiotherapy. All eventually failed in the treatment field; their 5-year actuarial survival and local control rates were zero. The other six were irradiated without residual macroscopic disease. Five of the six (83%) were able to complete WAXRT as planned without prolonged delays. The 5-year actuarial survival and local control rates for this group were 21 and 25%, respectively. The actuarial laparotomy rate to relieve bowel obstruction following WAXRT was 40% at 2 years. The results from this and other series indicate that salvage WAXRT is not effective for patients irradiated with macroscopic tumor. However, WAXRT appears to be potentially curative for a small but significant percentage of patients irradiated without gross disease, although the risk of significant complications is high.

Adjuvant whole-abdominal radiation therapy in uterine papillary serous carcinoma

Adjuvant whole-abdominal radiation therapy in uterine papillary serous carcinoma

Extragonadal sex cord tumor with annular tubules in an umbilical hernia sac: A unique presentation with implications for histogenesis

A sex cord tumor with annular tubules (SCTAT) was found incidentally in an umbilical hernia sac excised from a 66-year-old female. No ovarian lesions were visualized on a computerized tomographic (CT) scan of the pelvis. An exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymph node biopsies, and omentectomy likewise showed no gross evidence of tumor. Histologic examination revealed foci of SCTAT scattered in the omentum. The peritoneal washings were positive. The ovaries and pelvic lymph nodes were free of tumor. A second-look laparotomy following six courses of chemotherapy with cyclophosphamide, actinomycin D, and vincristine revealed microscopic tumor deposits in the base of the omental remnant, small bowel mesentery, anterior abdominal peritoneum, and meso-appendix. Clinically, the patient remains well following treatment with whole-abdominal radiation. To our knowledge, this is the first report of SCTAT in the umbilical region and the only case of SCTAT without an identifiable ovarian primary. The literature is reviewed, and the possible histogenesis of the tumor in this location is discussed.

Salvage therapy with whole-abdominal irradiation in patients with advanced carcinoma of the ovary previously treated by combination chemotherapy.

Whole-abdominal irradiation was delivered to 22 patients with epithelial carcinoma of the ovary who had persistent disease after chemotherapy. Seventeen patients were treated with an open whole-abdominal field and 5 with the moving-field technique. Eleven of the 22 also received a pelvic boost. Two of nine patients with microscopic disease at second look are alive and disease-free at 34 and 52 months, respectively. There were no salvages among the patient with macroscopic disease. Major complications included bowel obstruction in three patients and radiation enteritis in one patient. Whole-abdominal irradiation is not an effective salvage regimen after multiagent chemotherapy.

Determinants of survival of patients with epithelial ovarian carcinoma following whole abdominal irradiation (WAR)

Determinants of survival of patients with epithelial ovarian carcinoma following whole abdominal irradiation (WAR)

The treatment of ovarian cancer by a multimodality approach: remission induction with chemotherapy--hexa PAMP and PAMP regimens--followed by whole-abdominal radiation.

Seventy-six evaluable patients with ovarian carcinoma stages FIGO IIb, IIc, III, and IV, either received cis-platin (P) (80 mg/m2 iv. day 1), melphalan (PAM) (12 mg/m2 i.v. day 2) and hexamethylmelamine (HEXAPAMP) (135 mg/m2 orally days 8 to 21) or the same dose of cis-platin and melphalan but no hexamethylmelamine (PAMP) every four weeks. In 24 patients (32%) a surgically ascertained CR was achieved. 16 of these received follow-up radiation treatment to the whole abdomen. At present 19 patients are without relapse (average time 24 months). The trial has not been concluded. Particularly no predictions can be made on the value of follow-up radiation therapy in obtaining long-term remission rates.

Results of radiation therapy in the treatment of epithelial carcinoma of the ovary

Between 1967 and 1976, 82 patients who had epithelial carcinoma of the ovary and were treated with surgery and postoperative radiation therapy, respectively, were studied. Of these patients, 35% had Stage I disease, 16% Stage II, 45% Stage III, and 4% Stage IV. Serous cystadenocarcinoma was the histologic cell type in 54% of the patients, and mucinous cystadenocarcinoma was involved in 24%. Of the tumors, 35% were Grade 1, 34% Grade 2, 18% Grade 3, and 13% were unspecified. Survival at five years was 96% for Stage I patients, 60% for Stage II, and 60% for Stage III. No stage IV patient survived past two years. Stage III patients with no palpable tumor prior to radiation therapy did well, with 80% alive at more than two years, while only 10% of Stage III patients with palpable tumors prior to radiation therapy are alive. Patients with Stage III disease treated by whole-abdominal irradiation with a pelvic boost did better than those who received 3,000 rad or less to the pelvis. Radiation therapy continues to be an important treatment modality in epithelial carcinoma of the ovary, particularly in patients with minimal tumor burden.

A copper partial-transmission block for use in whole-abdominal radiation therapy for ovarian carcinoma.

A copper partial-transmission block has been devised for use in abdomino-pelvic irradiation, permitting treatment of the pelvis at the conventional dose rate for therapy of the pelvis alone while treating the abdomen at a readily tolerated dose rate.