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Recurrent ovarian cancer. Effective radiotherapeutic palliation after chemotherapy failure
Author(s) -
Corn Benjamin W.,
Lanciano Rachelle M.,
Boente Matthew,
Hunter W. Michael,
Ladazack John,
Ozols Robert F.
Publication year - 1994
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19941201)74:11<2979::aid-cncr2820741114>3.0.co;2-b
Subject(s) - medicine , palliative care , chemotherapy , radiation therapy , ovarian cancer , abdomen , cisplatin , cancer , surgery , nursing
Background . Recurrent ovarian cancer after frontline chemotherapy is incurable; however, palliation of focal lesions often is needed to alleviate symptoms. Because published response rates to palliative irradiation (RT) among patients failing cisplatin‐based chemotherapy are scarce, the authors attempted to define the palliative role of radiotherapy for symptomatic, localized ovarian cancer recurrences. Factors predicting a response to RT also were sought. Methods . Between 1987 and 1993, 33 patients with ovarian cancer were irradiated at 47 sites with palliative intent after failing cisplatin‐based chemotherapy regimens. Sites irradiated included the pelvis (n = 3), abdomen (n = 5), chest (n = 4), brain (n = 3), and other (n = 2). Median RT dose was 35 Gy (range: 7.5‐45 Gy). The median fraction size was 2.5 Gy (range, 1‐5 Gy). To determine dose effectiveness, the biologic effective dose (BED) was calculated according to the following formula: BED = total dose (1 + fractional dose/α/β) using an α/β value of 10. The median BED 10 Was 44 (range, 9–72). Results . For the entire group, complete palliative response was 51% and overall palliative response was 79%. The median duration of palliation was 4 months, which reflected palliation until death in 90% of cases. The overall response rates by symptoms were: pulmonary symptom relief in 75%, vaginal bleeding control in 90%, rectal bleeding control in 85%, pain relief in 83%, and neurologic symptoms controlled in 50%. The likelihood of obtaining complete symptomatic response was significantly increased among those with high Karnofsky performance status (KPS ⩾ 70 vs. KPS < 70; 69% vs. 36%, P < 0.03) and among those who received a higher biologically effective dose of irradiation (BED 10 ⩾ 44 vs. BED 10 < 44; 68% vs 35%, P < 0.03). Complete palliative response rates were not influenced by histologic differentiation, the number of previously administered cisplatin regimens, or patient age. Treatment‐related acute morbidities included diarrhea in 5 of 38 (13%) patients treated through abdominal or pelvic fields, and esophagitis in 2 of 5 treated through thoracic portals. Only one severe late morbidity (small bowel obstruction) was observed. Conclusions . Durable palliation of patients with ovarian cancer that recurs after cisplatin‐based chemotherapy can be achieved with local radiotherapy, especially among patients with high performance status. Biologically effective doses of at least 44 Gy 10 (e. g., 3500 cGy/ 14 fractions = BED 10 of 44) should be sought to maximize the probability of complete response. Such dose‐fractionation schedules can be delivered expeditiously with acceptable tolerance. These results are comparable to the published experience of second‐line chemotherapy in the treatment of focally symptomatic ovarian cancer recurrences.