Radiation for persistent or recurrent epithelial ovarian cancer: a need for reassessment

Choi, Nam Kyong; Chang, Ji Hyun; Kim, Su Zy; Kim, Hak Jae

doi:10.3857/roj.2017.00213

Cited by 19 publications

(17 citation statements)

References 31 publications

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“…No grade 3/4 toxicities were observed in either study. 12,13 In line with previous reports, 14,15 in the current study, platinum sensitivity at the time of RT was not associated with the tumor response to RT or survival after RT (Fig. 2c, Table S3).…”

Section: Discussionsupporting

confidence: 92%

Radiotherapy for isolated recurrent epithelial ovarian cancer: A single institutional experience

Komura

Mabuchi

Isohashi

et al. 2019

J of Obstet and Gynaecol

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Aim To evaluate the efficacy and toxicity of external beam radiotherapy (RT) for isolated recurrent epithelial ovarian cancer (EOC). Methods Twenty‐four isolated recurrent EOC patients treated with RT at Osaka University Hospital between January 2000 and January 2017 were included in the current study. Data regarding the primary or recurrent diseases, follow‐up findings, and efficacy or toxicities of RT were collected and retrospectively analyzed. Survival rates were calculated using the Kaplan–Meier method and compared using the log‐rank test. Results Their median age was 59 years. Most patients had International Federation of Gynecology and Obstetrics stage III‐IV diseases at the initial diagnosis. Histologically, serous adenocarcinoma was predominant, followed by clear cell adenocarcinoma. All patients had received at least one regimen of platinum‐based chemotherapy; 8 were platinum‐sensitive relapse and the others were platinum‐resistant. Lymph nodes were the most common sites of recurrence, and the median tumor size was 25.5 mm. The median total dose of RT administered was 54 Gy, with a median daily dose of 2 Gy. RT was well‐tolerated, and no patients experienced Grade 3/4 toxicities. The in‐field overall response rate was 58.3% (14/24), the median regression rate was −40.2% (range: −100 to 0) and the median survival period after RT was 17 months. The 1‐year survival and local progression‐free survival rates after RT were 66.7% and 45.8%, respectively. Conclusion RT showed significant antitumor effect against isolated recurrent EOC without causing severe toxicities. Prospective studies with sufficient statistical power are warranted to further evaluate the role of RT in this patient population.

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Section: Discussionsupporting

confidence: 92%

Radiotherapy for isolated recurrent epithelial ovarian cancer: A single institutional experience

Komura

Mabuchi

Isohashi

et al. 2019

J of Obstet and Gynaecol

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“…In our study, the 2-year OS, LC, RFS rates were 68.4%, 100%, and 66.6%, respectively, which were all higher than those reported by Chundury et al (63%, 82%, and 11%, respectively). This might be due to the higher radiation dose used in the present study, which had an average dose of 59.1 Gy (BED 45-82 Gy) 4,9,10 . Previous studies have shown that using 50 Gy as the BED limit increased the incidence of complete remission (CR).However, when 60 Gy was used as the BED limit, the CR rate showed no significant improvement 4,9,10 .…”

Section: Discussionmentioning

confidence: 88%

“…This might be due to the higher radiation dose used in the present study, which had an average dose of 59.1 Gy (BED 45-82 Gy) 4,9,10 . Previous studies have shown that using 50 Gy as the BED limit increased the incidence of complete remission (CR).However, when 60 Gy was used as the BED limit, the CR rate showed no significant improvement 4,9,10 . In contrast, the present study showed that a radiotherapy dose of ≥ 60 Gy significantly improved the survival of patients (P = 0.046, Fig.…”

Section: Discussionmentioning

confidence: 88%

“…With the advancement of radiotherapy technology and the corresponding reduction of toxicities, radiotherapy has been widely utilized in the treatment of recurrent ovarian cancer. Studies on various radiotherapy techniques, including salvage radiotherapy for locally recurrent sites, intracavitary radiotherapy, and prophylactic pelvic radiotherapy have achieved satisfactory results 4,[9][10][11][12][13] . Definitive IFRT can yield excellent local control, protracted disease-free intervals, so RT was considered a tool in the curative management of locoregionally-recurrent ovarian cancer 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Radiotherapy's value is more evident in the treatment of patients with recurrent ovarian cancer. In recent studies, radiotherapy of patients with recurrent ovarian cancer increased 5-year survival rates when compared to literature values of less than 20% [4][5][6][7][8][9][10] .…”

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confidence: 81%

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Clinical analysis of conformal and intensity-modulated radiotherapy in patients with recurrent ovarian cancer

Yang

Zhang

et al. 2020

Sci Rep

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We aimed to provide evidence for radiotherapy treatment regimens in patients with clinically recurrent ovarian cancer. We analyzed the survival and prognostic factors in 43 patients who were treated for recurrent ovarian cancer at 58 tumor sites using three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) during January 2006–December 2017. t years 1, 2, and 3, overall survival (OS) rate was 82.4%, 68.4%, and 57.9%; local control (LC) rate was 100%, 100% and 80%; recurrence free survival (RFS) rate was 86.8%, 66.6%, and 61.1%; and disease-free survival (DFS) rate was 79.7%, 56.7%, and 46.8%, respectively. The radiotherapy technique was determined to be an independent prognostic factor for survival; the survival rate of patients was significantly improved with IMRT compared to 3D-CRT (P = 0.035). Radiotherapy dose was an independent prognostic factor; survival rate improved when patients were treated with a radiation dose ≥ 60 Gy as compared to < 60 Gy (P = 0.046). Elective nodal prophylactic radiation therapy (ENRT) did not lead to a significant improvement in survival when compared to involved-field radiation therapy (IFRT). The toxicities of 3D-CRT and IMRT were tolerable. One patient (2.3%) had grade 3 acute gastrointestinal (GI) toxicity, 2 (4.6%) grade 3 late GI toxicity, 5 (11.6%) grade 3 hematological toxicity, and 2 (4.6%) had grade 4 hematological toxicity. IMRT improved LC and OS in patients with recurrent ovarian cancer after surgery and multiple chemotherapy; toxicities were tolerable. The IMRT technique and radiotherapy dose of ≥ 60 Gy had independent prognostic significance for the survival of such patients.

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Clinical application of radiotherapy in patients with oligometastatic ovarian cancer: a sharp tool to prolong the interval of systemic treatment

Shen

Tao

et al. 2022

Discov Onc

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Background With the advances of radiation technology, treatment of oligometastatic disease, with limited metastatic burden, have more chances to achieve long-term local control. Here we aim to evaluate the efficacy and safety of radiotherapy (RT) in oligometastatic ovarian cancer patients. Methods A retrospective analysis collecting 142 patients (189 lesions) with oligometastatic ovarian cancer were included in the study. All pateints received radiotherapy and the curative effect and response rate were evaluated by diagnostic imaging after 1–3 months of radiotherapy with RECIST. Endpoints were the rate of complete response (CR), chemotherapy-free interval (CFI), local control (LC) rate and overall survival (OS) rate. Toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG). Logistic and Cox regression were used for the uni- and multivariate analysis of factors influencing survival outcomes. Results From 2013.1.1 to 2020.12.30, a total of 142 ovarian cancer patients (189 oligometastasis lesions) were included in the analysis. Prescribed doses to an average GTV of 3.10 cm were 1.8–8 Gy/fraction, median BED (28–115, a/b = 10 Gy), 5–28 fractions. For 179 evaluable lesions, the cases of CR, partial response (PR), stable disease (SD) and progressive disease (PD) after radiotherapy were 22,39,38 and 80 respectively. The disease control rate (DCR): CR + PR + SD was 55.31%, and the objective response rate (ORR): CR + PR was 34.08%. No patient developed grade 3 or higher side effect. The median CFI was 14 months (1–99 months), and the LC rate was 69.7%, 54.3% and 40.9% in 1 year, 2 years and 5 years respectively. GTV < 3 cm before treatment, platinum sensitivity, time from the last treatment ≥ 6 months, single lesion and BED(a/b = 10 Gy) ≥ 60 are the factors of good LC (p < 0.05). The total OS of 1 year, 2 years and 5 years were 67.1%, 52.6% and 30.3%, respectively. Single lesion (HR 0.598, 95%CI 0.405–0.884), DCR (HR 0.640, 95% CI 0.448–0.918) and ORR(HR 0.466, 95% CI 0.308–0.707) were the significant factors influencing 5-year OS. Conclusion For patients with oligometastatic ovarian cancer, radiotherapy has high LC, long chemotherapy-free interval, and survival benefits. Subgroup analysis shows that patients with single lesion and good local treatment results have higher overall survival rate, suggesting that active treatment is also beneficial for oligometastatic ovarian cancer patients.

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Radiation for persistent or recurrent epithelial ovarian cancer: a need for reassessment

Cited by 19 publications

References 31 publications

Radiotherapy for isolated recurrent epithelial ovarian cancer: A single institutional experience

Radiotherapy for isolated recurrent epithelial ovarian cancer: A single institutional experience

Clinical analysis of conformal and intensity-modulated radiotherapy in patients with recurrent ovarian cancer

Clinical application of radiotherapy in patients with oligometastatic ovarian cancer: a sharp tool to prolong the interval of systemic treatment

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