J Gynecol Oncol.  2019 Sep;30(5):e67. 10.3802/jgo.2019.30.e67.

Involved-field radiation therapy for selected cases of recurrent ovarian cancer

• Kim N
• Chang JS
• Kim SW
• Kim GM
• Lee JY
• Kim YB

• KMID: 2457149
• DOI: http://doi.org/10.3802/jgo.2019.30.e67

Abstract

OBJECTIVES
In our institutional experience, involved-field radiation therapy (IFRT) yields favorable outcomes in patients with recurrent epithelial ovarian cancer (EOC). This retrospective study aimed to investigate the clinical benefits of IFRT in this patient population.
METHODS
Among patients treated with IFRT for recurrent EOC between 2010 and 2017, 61 patients with 90 treatments were included. IFRT encompassed all treatable lesions identified via imaging studies with 10-15-mm margins. Prescribed doses were ≥45 Gy (equivalent dose in 2 Gy/fraction).
RESULTS
Patients were followed up for a median of 19.0 (Interquartile range, 8.6-34.9) months after IFRT. The 2-year in-field control, progression-free survival, and overall survival (OS) rates were 42.7%, 24.2%, and 78.9%, respectively. Fifty-three IFRT sessions (58.9%) were followed by systemic chemotherapy, and the median chemotherapy-free interval (CFI) was 10.5 (95% confidence interval=7.3-13.7) months. A higher carbohydrate antigen-125 (CA-125) level correlated with a worse 2-year OS (69.2% vs. 91.0%; p=0.001) and shorter median CFI (4.7 vs. 11.9 months; p<0.001). Twenty-eight (31.1%) of 90 treatments yielded a long-term CFI >12 months. For patients with a normal CA-125 level and/or platinum-sensitive tumor, IFRT prolonged CFI regardless of pre-existing carcinomatosis, gross tumor volume, and number of treatment sites.
CONCLUSION
Our early experience demonstrates the safety and feasibility of IFRT as an effective salvage therapy and enables a "chemotherapy holiday" in selected recurrent EOC settings. The CA-125 value before IFRT (within normal range) and/or platinum sensitivity could be used as selection criteria for IFRT.

Keyword

Ovarian Cancer; Recurrent; Radiation Therapy; CA-125 Antigen; Platinum Sensitivity

MeSH Terms

CA-125 Antigen
Carcinoma
Disease-Free Survival
Drug Therapy
Humans
Ovarian Neoplasms*
Patient Selection
Platinum
Retrospective Studies
Salvage Therapy
Tumor Burden
CA-125 Antigen
Platinum