Treatment of ovarian cancer with surgery, short-course chemotherapy and whole abdominal radiation

Abstract

SummaryBackground: The primary aim was to induce a high number of pCR in early (FIGO IC, KB + C) -and advanced (FIGO rQ-IV) -stage ovarian cancer with a surgery plus 4 cycles of cisplatin and melphalan (PAMP) regimen. The second objective was to prevent relapse with WAR in patients in remission after chemotherapy.Patients and methods: 218 eligible patients were treated after staging laparotomy with cisplatin 80 mg/sqm i.v. on day 1 and melphalan 12 mg/sqm i.v. on day 2 q 4 weeks. Response was verified by second-look laparotomy. WAR was carried out with the open field technique on a linear accelerator (daily dose: 1.3 Gy, total dose: 29.9 Gy) in patients with pathological or clinical CR or pathological PR with microscopical residual disease.Results: 146/218 patients (67%, 95% CI: 61%-73%) responded to PAMP: 56 (26%) achieved pCR, 24 (11%), cCR, 56 (26%) pPR and 10 (5%) cPR (c = clinical, p = pathological). Multivariate analyses revealed that in advanced stages (92 cases in remission), the achievement of

Consolidation treatment of advanced (FIGO stage III) ovarian carcinoma in complete surgical remission after induction chemotherapy: A randomized, controlled, clinical trial comparing whole abdominal radiotherapy, chemotherapy, and no further treatment

“…Consolidation radiotherapy has been evaluated in a number of reports during the past decade (5,(10)(11)(12)14,(26)(27)(28)(29)(30)(31)(32)(33) . Negative outcomes are reported in a number of these studies (5,(26)(27)(28)31,33) .…”

“…Negative outcomes are reported in a number of these studies (5,(26)(27)(28)31,33) . More promising results are presented by others (10)(11)(12)14,29,30,32) , even though most series are small and not randomized.…”

“…Whole abdominal radiotherapy has also been used as consolidation treatment after primary surgery and induction chemotherapy (5,(26)(27)(28)(29)(30)(31)(32) . Prerequisites for successful treatment with minimal morbidity were proposed by Thomas in 1993 (10) .…”

“…A possible benefit of this treatment option has been noted for patients with tumors in complete pathologic remission or with minimal residual disease (32) . Acute hematologic toxicity (27,32) and delayed intestinal side effects are reported to be significant problems in some trials. A lack of randomized and controlled trials has prevented drawing firm conclusions about the value of radiotherapy for this group of patients (31) .…”

Radiation therapy for gynecologic cancer

“…For this reason there has been much interest in consolidation therapy following standard primary chemotherapy to prevent relapse. Although most trialist groups entertain additional systemic chemotherapy for consolidation, some investigators have given thought to utilizing consolidation WAR to a total dose of 30 Gy for patients who have had a complete clinical response 79 . A few centers continue to employ WAR exclusively in the adjuvant setting and claim satisfactory response rates, survivorship and toxicity profiles 80 …”