title: Intensity modulated radiation therapy for recurrent ovarian cancer refractory to chemotherapy.
abstract: OBJECTIVE
  To evaluate local control, survival outcomes, and toxicity after intensity modulated radiotherapy (IMRT) for recurrent chemorefractory ovarian cancer.
  
  
  METHODS
  Between 2006 and 2014, 33 patients were treated with IMRT for recurrent ovarian cancer. Patients received a median of 3 chemotherapy regimens prior to IMRT (range, 1-12) with 11 (33%) undergoing concurrent therapy. Local control (LC), recurrence free survival (RFS), and overall survival (OS) were calculated via Kaplan-Meier method. Toxicity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Impact of patient characteristics on outcomes was evaluated via Cox's proportional hazard model.
  
  
  RESULTS
  Median follow up was 23.7 months. Forty-nine sites were treated to a median dose of 5040cGy (range, 4500-7000). Nine (18%) of the 49 sites had in-field failures. Two year actuarial LC, RFS, and OS were 82%, 11%, and 63%, respectively. Seventeen patients had both a pre and post-treatment FDG-PET/CT; 6 (35%) had a complete metabolic response while 11 (65%) had a partial metabolic response. Acute ≥ grade 3 gastrointestinal (GI) toxicities occurred in 2 (6%) patients, late ≥ grade 3 GI toxicities occurred in 12 (36%), acute ≥ grade 3 hematological toxicities occurred in 5 (15%) and late ≥ grade 3 hematological toxicities occurred in 14 (42%).
  
  
  CONCLUSIONS
  IMRT for recurrent chemorefractory ovarian cancer is associated with excellent local control and limited radiation related toxicity. Future studies will be required to determine which subpopulation will benefit most from IMRT and whether alternative techniques such as stereotactic body radiotherapy may be feasible.
authors.affiliation: Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Anupama
authors.initials: A
authors.lastname: Chundury
authors.affiliation: Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Apicelli
authors.affiliation: Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: DeWees
authors.affiliation: Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Powell
authors.affiliation: Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: David
authors.initials: D
authors.lastname: Mutch
authors.affiliation: Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Premal
authors.initials: P
authors.lastname: Thaker
authors.affiliation: Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Clifford
authors.initials: C
authors.lastname: Robinson
authors.affiliation: Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Perry W
authors.initials: PW
authors.lastname: Grigsby
authors.affiliation: Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: jschwarz@radonc.wustl.edu.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Schwarz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects
keywords: Ovarian; Radiotherapy; Recurrent