Long-term morbidity of adjuvant whole abdominal radiotherapy (WART) or chemotherapy for early stage ovarian cancer.
The aim of the study was to evaluate long-term toxicity of adjuvant treatment in early stage ovarian cancer survivors. Data from all patients treated in one hospital for early stage ovarian cancer diagnosed between 1980 and 1990 were collected using a structured data form. In 93 FIGO stages I and II patients, cytoreductive and staging surgery was performed; 15 received no adjuvant treatment (controls), 39 whole abdominal radiotherapy (WART) and 39 platin-based chemotherapy. Median age at diagnosis was 54 years (range 21-83 years). During follow-up, 49/93 (53%) patients have died with a median overall survival of 18.4 years (95% CI 12.8-23.9). In both the radiotherapy and the chemotherapy group, 50% of patients reported long-term side-effects (all grades) versus 13% of controls. Two patients in the WART group died from bowel complications. Secondary malignancies were observed in 16 patients. Of all patients alive at the last follow-up, 12/17 (71%) patients treated with radiotherapy and 11/18 (61%) treated with chemotherapy experienced long-term morbidity versus 2/9 (22%) controls (P=0.03).


CONCLUSIONS
Long-term follow-up of early stage ovarian cancer patients showed lasting GI morbidity in the survivors treated with adjuvant radiotherapy, which has therefore become obsolete. Cisplatin-based chemotherapy caused peripheral neuropathy versus virtual absence of problems in the survivors of just surgery, emphasising the need for strict criteria before instigating adjuvant treatment.
Engelen
M J A
MJA
Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Snel
B J
BJ
Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Schaapveld
M
M
Department of Epidemiology and Statistics, Comprehensive Cancer Centre North Netherlands, P.O. Box 330, 9700 AH Groningen, The Netherlands.
Pras
E
E
Department of Radiotherapy, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
de Vries
E G E
EGE
Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Gietema
J A
JA
Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
van der Zee
A G J
AGJ
Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Willemse
P H B
PHB
Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands. Electronic address: p.h.b.willemse@int.umcg.nl.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D002945:Cisplatin / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000150:complications / Q000401:mortality; D006331:Heart Diseases / Q000150:complications / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000401:mortality; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000401:mortality; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents; D002945:Cisplatin