Adjuvant whole abdominal intensity modulated radiotherapy (IMRT) for high risk stage FIGO III patients with ovarian cancer (OVAR-IMRT-01) - Pilot trial of a phase I/II study: study protocol.
BACKGROUND
The prognosis for patients with advanced epithelial ovarian cancer remains poor despite aggressive surgical resection and platinum-based chemotherapy. More than 60% of patients will develop recurrent disease, principally intraperitoneal, and die within 5 years. The use of whole abdominal irradiation (WAI) as consolidation therapy would appear to be a logical strategy given its ability to sterilize small tumour volumes. Despite the clinically proven efficacy of whole abdominal irradiation, the use of radiotherapy in ovarian cancer has profoundly decreased mainly due to high treatment-related toxicity. Modern intensity-modulated radiation therapy (IMRT) could allow to spare kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose.


METHODS
The OVAR-IMRT-01 study is a single center pilot trial of a phase I/II study. Patients with advanced ovarian cancer stage FIGO III (R1 or R2< 1 cm) after surgical resection and platinum-based chemotherapy will be treated with whole abdomen irradiation as consolidation therapy using intensity modulated radiation therapy (IMRT) to a total dose of 30 Gy in 1.5 Gy fractions. A total of 8 patients will be included in this trial. For treatment planning bone marrow, kidneys, liver, spinal cord, vertebral bodies and pelvic bones are defined as organs at risk. The planning target volume includes the entire peritoneal cavity plus pelvic and para-aortic node regions.


CONCLUSIONS
The primary endpoint of the study is the evaluation of the feasibility of intensity-modulated WAI and the evaluation of the study protocol. Secondary endpoint is evaluation of the toxicity of intensity modulated WAI before continuing with the phase I/II study. The aim is to explore the potential of IMRT as a new method for WAI to decrease the dose to kidneys, liver, bone marrow while covering the peritoneal cavity with a homogenous dose, and to implement whole abdominal intensity-modulated radiotherapy into the adjuvant multimodal treatment concept of advanced ovarian cancer FIGO stage III.
Rochet
Nathalie
N
Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. nathalie.rochet@gmail.com
Jensen
Alexandra D
AD
Sterzing
Florian
F
Munter
Marc W
MW
Eichbaum
Michael H
MH
Schneeweiss
Andreas
A
Sohn
Christof
C
Debus
Juergen
J
Harms
Wolfgang
W
D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D017321:Clinical Trials, Phase I as Topic / Q000941:ethics / Q000379:methods*; D017322:Clinical Trials, Phase II as Topic / Q000941:ethics / Q000379:methods*; D019583:Dose Fractionation, Radiation; D023381:Endpoint Determination; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009928:Organ Specificity; D010051:Ovarian Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D018579:Patient Selection; D010865:Pilot Projects; D011832:Radiation Injuries / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D011882:Radiotherapy, High-Energy / Q000295:instrumentation / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation; D012107:Research Design; D012306:Risk