Whole abdominopelvic radiotherapy using intensity-modulated arc therapy in the palliative treatment of chemotherapy-resistant ovarian cancer with bulky peritoneal disease: a single-institution experience.
OBJECTIVE
To retrospectively review our experience with whole abdominopelvic radiotherapy (WAPRT) using intensity-modulated arc therapy in the palliative treatment of chemotherapy-resistant ovarian cancer with bulky peritoneal disease.


METHODS
Between April 2002 and April 2008, 13 patients were treated with WAPRT using intensity-modulated arc therapy. We prescribed a dose of 33 Gy to be delivered in 22 fractions of 1.5 Gy to the abdomen and pelvis. All patients had International Federation of Gynecology and Obstetrics Stage III or IV ovarian cancer at the initial diagnosis. At referral, the median age was 61 years, and the patients had been heavily pretreated with surgery and chemotherapy. All patients had symptoms from their disease, including gastrointestinal obstruction or subobstruction in 6, minor gastrointestinal symptoms in 2, pain in 4, ascites in 1, and vaginal bleeding in 2. A complete symptom or biochemical response required complete resolution of the patient's symptoms or cancer antigen-125 level. A partial response required ≥50% resolution of these parameters. The actuarial survival was calculated from the start of radiotherapy.


RESULTS
The median overall survival was 21 weeks, with a 6-month overall survival rate of 45%. The 9 patients who completed treatment obtained a complete symptom response, except for ascites (partial response). The median and mean response duration (all symptoms grouped) was 24 and 37 weeks, respectively. Of the 6 patients presenting with obstruction or subobstruction, 4 obtained a complete symptom response (median duration, 16 weeks).


CONCLUSIONS
WAPRT delivered using intensity-modulated arc therapy offers important palliation in the case of peritoneal metastatic ovarian cancer. WAPRT resolved intestinal obstruction for a substantial period.
De Meerleer
Gert
G
Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium. gert.demeerleer@uzgent.be
Vandecasteele
Katrien
K
Ost
Piet
P
Delrue
Louke
L
Denys
Hannelore
H
Makar
Amin
A
Speleers
Bruno
B
Van Belle
Simon
S
Van den Broecke
Rudy
R
Fonteyne
Valérie
V
De Neve
Wilfried
W
D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D000077216:Carcinoma, Ovarian Epithelial; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000532:radiotherapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D009375:Neoplasms, Glandular and Epithelial; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D010166:Palliative Care / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden
D018394:CA-125 Antigen