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Intraoperative radiotherapy electron boost in advanced and recurrent epithelial ovarian carcinoma: a retrospective study.

Gao Y, Liu Z, Chen X, Luo W, Zhang L, Wang J - BMC Cancer (2011)

Bottom Line: All 45 patients in this series underwent optimal cytoreductive (≤ 1 cm) surgery.Eight of 25 (32%) local failures were observed in the PD group, as compared to 6/20 (30%) in the ILR group (P = 0.885).Nine of 25 (36%) in the PD group died, as compared to 8 of 20 (40%) in the ILR group.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Department of Radiotherapy Oncology in the 1st Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an, 710061, China.

ABSTRACT

Background: Relapses of epithelial ovarian carcinoma (EOC) have a poor prognosis and are almost always fatal. The aim of this study was to evaluate the clinical outcome and toxicity of intraoperative electron beam radiation therapy (IOERT) in advanced and recurrent EOC.

Methods: Forty-five women with EOC were treated with IOERT. Twenty-five patients had primary disease (PD) without distant metastasis at IOERT, and 20 patients had an isolated local recurrence (ILR) after surgery. All 45 patients in this series underwent optimal cytoreductive (≤ 1 cm) surgery. The whole pelvic (WP) radiotherapy was intraoperatively delivered using 12 Mev electron beam; 43 patients received 18-20 Gy and two patients received 10 Gy. Thirty-three patients received postoperateive intraperitoneal (IP) chemotherapy, while seven patients received intravenous (IV) chemotherapy. Five patients refused concurrent chemotherapy. Overall survival (OS) rates were analyzed using the Kaplan-Meier method.

Results: Tumor recurrence and metastasis were observed in 16 patients (35.6%). Of those, 14 patients (31.1%) relapsed and two patients (4.4%) had distant metastasis alone. Eight of 25 (32%) local failures were observed in the PD group, as compared to 6/20 (30%) in the ILR group (P = 0.885). Actuarial local control at five year follow-up was 31/45 (68.9%). Seventeen of the total 45 (37.8%) patients died. Nine of 25 (36%) in the PD group died, as compared to 8 of 20 (40%) in the ILR group. The 5-year OS and disease-free survival (DFS) rates were 28/45 (62.2%) and 25/45 (55.6%), respectively. In the PD group, the 5-year OS and DFS rates were 16/25 (64%) and 14/25 (56%) (P > 0.05, vs. the ILR group at 12/20 and 11/20, respectively). The OS and DFS in the IOERT plus IP group were 25/33 (75.8%) and 23/33 (69.7%), respectively, which were superior to the rates achieved with IOERT plus IV chemotherapy (P < 0.05, 2/7 and 1/7, respectively). The major complication of IOERT was neuropathy. Five (11.1%) patients developed peripheral neurotoxicity.

Conclusions: IOERT may be feasible and effective as a boosting technique for advanced and recurrent ovarian cancer. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. Peripheral nerves in the IOERT field are dose-limiting structures requiring nerve protection policies or a dose compromise to ensure against severe neurological damage.

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Survival analysis in advanced and recurrent epithelial ovarian carcinoma after IOERT. a Overall-survival curve stratified for PD versus ILR (P > 0.05). b Disease-free survival survival curve stratified for PD versus ILR (P > 0.05). c Overall-survival curve stratified for IOERT+IP versus IOERT+IV (P < 0.05). d Disease-free survival curve stratified for IOERT+IP versus decreased IOERT+IV (P < 0.05).
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Figure 1: Survival analysis in advanced and recurrent epithelial ovarian carcinoma after IOERT. a Overall-survival curve stratified for PD versus ILR (P > 0.05). b Disease-free survival survival curve stratified for PD versus ILR (P > 0.05). c Overall-survival curve stratified for IOERT+IP versus IOERT+IV (P < 0.05). d Disease-free survival curve stratified for IOERT+IP versus decreased IOERT+IV (P < 0.05).

Mentions: The mean follow-up time was 78 months (range: 11-123 months). During that time, 17 of 45 (37.8%) patients died of disease. Nine of the 25 patients (36%) in the PD group died, as compared to eight of the 20 patients (40%) in the ILR group. The 5-year overall survival and disease-free survival rates were 28/45 (62.2%) and 25/45 (55.6%), respectively. In the PD group, the 5-year OS and DFS rates were 16/25 and 14/25 (P > 0.05 vs. the ILR group at 12/20 and 11/20, respectively) (Figure 1a and 1b). The OS and DFS in the IOERT plus IP group were 25/33 and 23/33, which were superior to those in the IOERT plus IV group (2/7 and 1/7, respectively; P < 0.05) (Figure 1c and 1d).


Intraoperative radiotherapy electron boost in advanced and recurrent epithelial ovarian carcinoma: a retrospective study.

Gao Y, Liu Z, Chen X, Luo W, Zhang L, Wang J - BMC Cancer (2011)

Survival analysis in advanced and recurrent epithelial ovarian carcinoma after IOERT. a Overall-survival curve stratified for PD versus ILR (P > 0.05). b Disease-free survival survival curve stratified for PD versus ILR (P > 0.05). c Overall-survival curve stratified for IOERT+IP versus IOERT+IV (P < 0.05). d Disease-free survival curve stratified for IOERT+IP versus decreased IOERT+IV (P < 0.05).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198723&req=5

Figure 1: Survival analysis in advanced and recurrent epithelial ovarian carcinoma after IOERT. a Overall-survival curve stratified for PD versus ILR (P > 0.05). b Disease-free survival survival curve stratified for PD versus ILR (P > 0.05). c Overall-survival curve stratified for IOERT+IP versus IOERT+IV (P < 0.05). d Disease-free survival curve stratified for IOERT+IP versus decreased IOERT+IV (P < 0.05).
Mentions: The mean follow-up time was 78 months (range: 11-123 months). During that time, 17 of 45 (37.8%) patients died of disease. Nine of the 25 patients (36%) in the PD group died, as compared to eight of the 20 patients (40%) in the ILR group. The 5-year overall survival and disease-free survival rates were 28/45 (62.2%) and 25/45 (55.6%), respectively. In the PD group, the 5-year OS and DFS rates were 16/25 and 14/25 (P > 0.05 vs. the ILR group at 12/20 and 11/20, respectively) (Figure 1a and 1b). The OS and DFS in the IOERT plus IP group were 25/33 and 23/33, which were superior to those in the IOERT plus IV group (2/7 and 1/7, respectively; P < 0.05) (Figure 1c and 1d).

Bottom Line: All 45 patients in this series underwent optimal cytoreductive (≤ 1 cm) surgery.Eight of 25 (32%) local failures were observed in the PD group, as compared to 6/20 (30%) in the ILR group (P = 0.885).Nine of 25 (36%) in the PD group died, as compared to 8 of 20 (40%) in the ILR group.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Department of Radiotherapy Oncology in the 1st Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an, 710061, China.

ABSTRACT

Background: Relapses of epithelial ovarian carcinoma (EOC) have a poor prognosis and are almost always fatal. The aim of this study was to evaluate the clinical outcome and toxicity of intraoperative electron beam radiation therapy (IOERT) in advanced and recurrent EOC.

Methods: Forty-five women with EOC were treated with IOERT. Twenty-five patients had primary disease (PD) without distant metastasis at IOERT, and 20 patients had an isolated local recurrence (ILR) after surgery. All 45 patients in this series underwent optimal cytoreductive (≤ 1 cm) surgery. The whole pelvic (WP) radiotherapy was intraoperatively delivered using 12 Mev electron beam; 43 patients received 18-20 Gy and two patients received 10 Gy. Thirty-three patients received postoperateive intraperitoneal (IP) chemotherapy, while seven patients received intravenous (IV) chemotherapy. Five patients refused concurrent chemotherapy. Overall survival (OS) rates were analyzed using the Kaplan-Meier method.

Results: Tumor recurrence and metastasis were observed in 16 patients (35.6%). Of those, 14 patients (31.1%) relapsed and two patients (4.4%) had distant metastasis alone. Eight of 25 (32%) local failures were observed in the PD group, as compared to 6/20 (30%) in the ILR group (P = 0.885). Actuarial local control at five year follow-up was 31/45 (68.9%). Seventeen of the total 45 (37.8%) patients died. Nine of 25 (36%) in the PD group died, as compared to 8 of 20 (40%) in the ILR group. The 5-year OS and disease-free survival (DFS) rates were 28/45 (62.2%) and 25/45 (55.6%), respectively. In the PD group, the 5-year OS and DFS rates were 16/25 (64%) and 14/25 (56%) (P > 0.05, vs. the ILR group at 12/20 and 11/20, respectively). The OS and DFS in the IOERT plus IP group were 25/33 (75.8%) and 23/33 (69.7%), respectively, which were superior to the rates achieved with IOERT plus IV chemotherapy (P < 0.05, 2/7 and 1/7, respectively). The major complication of IOERT was neuropathy. Five (11.1%) patients developed peripheral neurotoxicity.

Conclusions: IOERT may be feasible and effective as a boosting technique for advanced and recurrent ovarian cancer. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. Peripheral nerves in the IOERT field are dose-limiting structures requiring nerve protection policies or a dose compromise to ensure against severe neurological damage.

Show MeSH
Related in: MedlinePlus