title: Salvage whole-abdominal radiation therapy after second-look laparotomy or secondary debulking surgery in patients with ovarian cancer.
abstract: OBJECTIVE
  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.
authors.affiliation: Section of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Metzinger
authors.forename: John B
authors.initials: JB
authors.lastname: Gebhart
authors.forename: Preeti
authors.initials: P
authors.lastname: Srivatsa
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.forename: Vera J
authors.initials: VJ
authors.lastname: Suman
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D010051:Ovarian Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D024162:Second-Look Surgery; D015996:Survival Rate; D016896:Treatment Outcome