Salvage radiation therapy for localized recurrent ovarian cancer

Alicia Smart; Yu-Hui Chen; Teresa Cheng; Martin King; Larissa Lee

doi:10.1136/ijgc-2019-000247

Salvage radiation therapy for localized recurrent ovarian cancer

Int J Gynecol Cancer. 2019 May 2:ijgc-2019-000247. doi: 10.1136/ijgc-2019-000247. Online ahead of print.

Authors

Alicia Smart¹, Yu-Hui Chen², Teresa Cheng², Martin King², Larissa Lee³

Affiliations

¹ Harvard Medical School, Boston, Massachusetts, USA.
² Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
³ Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA LLEE13@Partners.org.

PMID: 31053659
DOI: 10.1136/ijgc-2019-000247

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.

Keywords: neoplasm recurrence, local; ovarian cancer; radiation oncology.