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Original Article
Salvage radiation therapy for localized recurrent ovarian cancer
  1. Alicia Smart1,
  2. Yu-Hui Chen2,
  3. Teresa Cheng2,
  4. Martin King2 and
  5. Larissa Lee2
  1. 1 Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
  1. Correspondence to Dr Larissa Lee, Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA 02115, USA; LLEE13{at}Partners.org

Abstract

Introduction To evaluate clinical outcomes for patients with localized recurrent ovarian cancer treated with salvage radiotherapy.

Methods In a retrospective single institutional analysis, we identified 40 patients who received salvage radiotherapy for localized ovarian cancer recurrence from January 1995 to June 2011. Recurrent disease was categorized as: pelvic peritoneal (45%, 18), extraperitoneal/nodal (35%, 14), or vaginal (20%, eight). Actuarial disease-free and overall survival estimates were calculated by Kaplan–Meier and prognostic factors evaluated by the Cox proportional hazards model.

Results Median follow-up was 42 months. Median patient age was 54 years (range, 27–78). Histologic subtypes were: serous (58%, 23), endometrioid (15%, six), clear cell (13%, five), mucinous (8%, three), and other (8%, three). At the time of salvage radiotherapy, surgical cytoreduction was performed in 60% (24) and 68% (27) had platinum-sensitive disease. Most patients (63%, 25) received salvage radiotherapy at the time of first recurrence. Relapse after salvage radiotherapy occurred in 29 patients at a median time of 16 months and was outside the radiotherapy field in 62%. 18 At 3 years, disease-free and overall survival rates were 18% and 80%, respectively. On multivariate analysis, non-serous histology (hazards ratio 0.3, 95% CI 0.1–0.7) and platinum-sensitivity (hazards ratio 0.2, 95% CI 0.1–0.5) were associated with lower relapse risk. Platinum-sensitivity was also associated with overall survival (hazards ratio 0.4, 95% CI 0.1–1.0). Four patients (10%) were long-term survivors without recurrence 5 years after salvage radiotherapy. Of the five patients with clear cell histology, none experienced relapse at the time of last follow-up.

Discussion Patients with non-serous and/or platinum-sensitive ovarian cancer had the greatest benefit from salvage radiotherapy for localized recurrent disease. Although relapse was common, radiotherapy prolonged recurrence for > 1 year in most patients and four were long-term survivors.

  • ovarian cancer
  • radiation oncology
  • neoplasm recurrence, local

https://doi.org/10.1136/ijgc-2019-000247

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    Footnotes

    • Contributors LL developed the study concept; AC, LL, and YC conducted data analyses; AC, LL, and TC were involved in manuscript work, including revisions. All authors have read and approved the final version for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests LL is the principal investigator of an investigator-initiated clinical trial sponsored by AstraZeneca, has received non-financial support from AstraZeneca, and grant support from the Koch Institute at the Massachusetts Institute of Technology.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No data are available.