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.