title: Whole abdomen radiation therapy after a short chemotherapy course and second-look laparotomy in advanced ovarian cancer.
abstract: 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 less than or equal to 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 less than 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.
authors.affiliation: Radiotherapy Department, Centro di Riferimento Oncologico, Aviano, (Pordenone), Italy.
authors.forename: G
authors.initials: G
authors.lastname: Franchin
authors.forename: S
authors.initials: S
authors.lastname: Tumolo
authors.forename: C
authors.initials: C
authors.lastname: Scarabelli
authors.forename: A
authors.initials: A
authors.lastname: De Paoli
authors.forename: G
authors.initials: G
authors.lastname: Boz
authors.forename: D
authors.initials: D
authors.lastname: Crivellari
authors.forename: M
authors.initials: M
authors.lastname: Arcicasa
authors.forename: R
authors.initials: R
authors.lastname: Bortolus
authors.forename: C
authors.initials: C
authors.lastname: Gobitti
authors.forename: E
authors.initials: E
authors.lastname: Minatel
mesh_terms: D000005:Abdomen / Q000528:radiation effects / Q000601:surgery*; D000328:Adult; D000368:Aged; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007274:Injections, Intraperitoneal; D007813:Laparotomy; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D013997:Time Factors
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin