The role of radiotherapy in ovarian cancer

Abstract

Epithelial ovarian cancer accounts for around 1.9% of all malignancies and often presents late at an advanced stage. Prognosis is therefore poor. Currently the mainstay of treatment is radical cytoreductive surgery and chemotherapy but, in the past, the standard of care also included adjuvant whole abdominal radiotherapy. This is no longer standard practice, largely due to high toxicity rates and the effectiveness of platinum-based chemotherapy. Presently, a role is emerging for modern radiotherapy techniques in both the salvage and palliative settings. This review aims to examine the historical use of radiotherapy in ovarian cancer before looking forward to its potential future role.

Prediction for 2-year mortality of metastatic ovarian cancer patients based on surveillance, epidemiology, and end results database

“…In addition, chemotherapy might be associated with some side-effects such as fatigue in patients, and intervention strategies should be proposed to improve the management of these patients during their treatment and in the long term ( 41 ). In the past, ovarian cancer was found to be a radiosensitive tumor, and radiation was one of the main therapies for patients with epithelial ovarian cancer, which was applied to manage patients with low residual volumes of disease ( 42 ). Nowadays, radiotherapy is replaced by some other therapies in the treatment of ovarian cancer as ovarian cancer is easily to metastasize to other organs, especially in the pelvic and abdominal cavity.…”

Role of salvage radiotherapy for recurrent ovarian cancer

“…Although most studies are based on small populations in a retrospective manner, there is growing evidence that selected patients with recurrent ovarian cancer may benefit from salvage radiotherapy. Survival varied between studies, with local failure-free survival ranging from 42.7% after 2 years to 71% after 5 years, and overall survival ranging from 78.9% after 2 years to 40% after 5 years 11 13 14 16 17…”

Ovarian Cancer Radiosensitivity: What Have We Understood So Far?

“…Nowadays, adjuvant whole abdominal radiotherapy (WART), commonly delivered in the past years for ovarian tumors, is no longer considered standard practice due to the high rate of toxicity (gastrointestinal, hematological, and bone) [ 1 ]; radical cytoreductive surgery and chemotherapy are the cornerstones of the treatment. WART showed good results in terms of a lower risk of failures [ 2 ] and also for the most uncommon histologies such as ovarian clear cell carcinoma [ 3 ], which is characterized by unique genotypic and phenotypic signatures and platinum resistance.…”

“…In recent years, RT has played an emerging role in salvage/palliative settings as well as in the prolongation of the chemotherapy-free interval [ 1 , 8 , 9 ] in oligorecurrent and oligometastatic disease. In particular, thanks to the most recent RT techniques, that allow the delivery of high and ablative doses, RT has lately been increasingly considered as an active treatment to combine with other approaches (i.e., surgery, chemotherapy, and novel target-based drugs) to palliate symptoms and/or to prolong chemotherapy-free-interval [ 1 , 8 , 9 ].…”

“…In recent years, RT has played an emerging role in salvage/palliative settings as well as in the prolongation of the chemotherapy-free interval [ 1 , 8 , 9 ] in oligorecurrent and oligometastatic disease. In particular, thanks to the most recent RT techniques, that allow the delivery of high and ablative doses, RT has lately been increasingly considered as an active treatment to combine with other approaches (i.e., surgery, chemotherapy, and novel target-based drugs) to palliate symptoms and/or to prolong chemotherapy-free-interval [ 1 , 8 , 9 ]. The clinical largest cohort (449 analyzed lesions) of stereotactic body RT (SBRT) for oligometastatic ovarian cancer described a high profile of efficacy and safety for this approach with a complete response rate of 65.2% and a 24-month actuarial local control rate of 81.9% [ 9 ].…”