Adjuvant whole abdominal radiotherapy in epithelial cancer of the ovary.
OBJECTIVE
To reexamine the use of adjuvant radiotherapy in optimally debulked patients.


METHODS
Between January 1985 and April 1998, 60 patients were treated with adjuvant whole abdominal radiotherapy (A-WART). The stage distribution was Stage IC in 17 patients, Stage II in 9, and Stage III in 34. The grade distribution was Grade 1 in 9 patients, Grade 2 in 27, and Grade 3 in 24; thus, 60% of the patients had Stage III disease and 40% had Grade 3 tumors. After surgery, no residuum was left in 42 (70%), <or=2 cm in 13 (22%), and >2 cm in 5 (8%) of 60 patients. Of the 60 patients, 19 also received platinum-based chemotherapy; in 12 of the 19, the chemotherapy was before A-WART. Thirty-seven of the patients had undergone previous abdominal procedures and a second-look operation was performed in 25% of them. A-WART consisted of 22 Gy in 22 fractions, at 5 fractions weekly in 90% of the patients. The remaining 10% received 25 Gy in 25 fractions within 5 weeks. The A-WART was delivered using a 4-MV linear accelerator. After abdominal irradiation, a boost to the pelvis was given to reach 45 Gy at 1.8 cGy/fraction, using a 4-15-MV linear accelerator.


RESULTS
Treatment was delivered in a median of 50 days (range 48-70). In 12 (20%) of the 60 patients, a transient treatment interruption occurred because of acute toxicity, mainly vomiting and diarrhea. The overall survival rate was 55% at 5 years (median follow-up 96.5 months). Patients with low-histologic grade tumors (Grade 1-2) had a better 5-year survival rate (66%) than those with Grade 3 tumors (35%; p <0.03). A tendency for better survival was found for those with Stage I-II than for those with Stage III (69% vs. 43%). Nonetheless, this difference did not reach statistical significance (p = 0.17). For patients receiving chemotherapy, the 5-year survival rate was 51%, not statistically different from the 58% 5-year survival rate observed among those patients without adjuvant chemotherapy (p = 0.9). The abdominal control rate was 83%. Thirty-five percent of the patients sustained acute Grade 2-3 complications. Late complications were observed in 6 of 60 patients, 4 had Grade 3 (7%) and 2 had Grade 4 (3%). Two patients died of intestinal occlusion, both had undergone previous abdominal procedures and in 1, no tumor was found in the abdomen at the postmortem examination.


CONCLUSIONS
A-WART achieves a quite favorable 5-year survival rate with a low complication rate in properly selected patients. A-WART should be included in the elective postoperative treatment of ovarian cancer patients who are at risk of abdominal failure, and this should be explored in a randomized trial.
Hepp
Rodrigo
R
Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile.
Baeza
Mario R
MR
Olfos
Patricio
P
Suarez
Eugenio
E
D000005:Abdomen; D000293:Adolescent; D000328:Adult; D000368:Aged; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods; D024162:Second-Look Surgery; D015996:Survival Rate