Salvage whole-abdominal radiation therapy after second-look laparotomy or secondary debulking surgery in patients with ovarian cancer

Gynecol Oncol. 2005 Feb;96(2):389-94. doi: 10.1016/j.ygyno.2004.10.007.

Abstract

Objectives: Our aim was to determine the outcomes associated with use of whole-abdominal radiation therapy (WART) in women with ovarian cancer, to identify predictors of response, and to assess associated toxicity.

Methods: From 1981 through 2000, 171 women received WART at our institution after ovarian cancer surgery. Relevant clinical information was extracted through retrospective chart review.

Results: One hundred nine patients received WART after positive second-look laparotomy (SLL), and 62 were treated after secondary debulking (SD) for recurrent disease. The median dose to the whole abdomen was 25.5 Gy (range, 1.0-30.5 Gy). Therapy included a pelvic boost in 120 patients (70%) and a para-aortic boost in 21 patients (12%). The planned radiation course was completed in 123 patients (72%). In the SLL group, 5-year survival was 29% with a median follow-up of 98.4 months. The 5-year progression-free survival (PFS) was 41% in those with microscopic disease. There was one treatment-related death (1%). For the SD group, median PFS was 11 months and associated with treatment-related mortality in 5%. Overall, treatment-related small bowel obstruction occurred in 26 patients (15%).

Conclusions: In patients with a positive SLL, WART should be considered only for those with microscopic residual disease. Treatment-related small bowel obstruction can be expected in 15% of these patients. Use of WART for recurrent disease appears to be related to serious bowel toxicity in 5% with an associated short disease-free interval; the therapeutic index of WART may not be acceptable in patients with recurrent disease regardless of the degree of cytoreduction.

MeSH terms

  • Combined Modality Therapy
  • Female
  • Gynecologic Surgical Procedures / methods
  • Humans
  • Laparotomy
  • Middle Aged
  • Neoplasm Recurrence, Local / radiotherapy
  • Ovarian Neoplasms / radiotherapy*
  • Ovarian Neoplasms / surgery*
  • Retrospective Studies
  • Salvage Therapy
  • Second-Look Surgery
  • Survival Rate
  • Treatment Outcome