Involved-field radiation therapy for locoregionally recurrent ovarian cancer

- Selected ovarian cancer patients with locoregionally-confined recurrences were treated with definitive involved-field radiation therapy (IFRT).
- IFRT produced high rates of in-field disease control/prolonged disease-free intervals of up to 10 years in some patients.
- Some patients with disease progression following IFRT may benefit from RT through longer breaks from chemotherapy.

ObjectiveTo evaluate the effectiveness of definitive involved-field radiation therapy (IFRT) for selected patients with locoregionally-recurrent ovarian cancer.MethodsWe retrospectively reviewed records of 102 epithelial ovarian cancer patients treated with definitive IFRT (≥ 45 Gy). IFRT was directed to localized nodal (49%) and extranodal (51%) recurrences.ResultsThe median time from diagnosis to IFRT was 36 months (range, 1-311), and the median follow-up after IFRT was 37 months (range, 1-123). Patients received a median of three chemotherapy courses before IFRT (range, 0-9). Five-year overall (OS) and progression-free survival (PFS) rates after IFRT were 40% and 24% respectively; the 5-year in-field disease control rate was 71%.Thirty-five patients (35%) had no evidence of disease at a median of 38 months after IFRT (range, 7-122), including 25 continuously without disease for a median of 61 months (range, 17-122) and 10 with salvage treatment following disease recurrence, disease-free for a median of 39 months after salvage treatment (range, 7-92).Eight clear cell carcinoma patients had higher 5-year OS (88% versus 37%; p = 0.05) and PFS (75% versus 20%; p = 0.01) rates than other patients. Patients sensitive to initial platinum chemotherapy had a higher 5-year OS rate than platinum-resistant patients (43% versus 27%, p = 0.03). Patients who required chemotherapy for recurrence after IFRT often benefitted from longer chemotherapy-free intervals after than before IFRT.ConclusionsDefinitive IFRT can yield excellent local control, protracted disease-free intervals, and even cures in carefully selected patients. RT should be considered a tool in the curative management of locoregionally-recurrent ovarian cancer.