DOI QR코드

DOI QR Code

Radiation for persistent or recurrent epithelial ovarian cancer: a need for reassessment

  • Choi, Noorie (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Chang, Ji Hyun (Department of Radiation Oncology, SMG-SNU Boramae Medical Center) ;
  • Kim, Suzy (Department of Radiation Oncology, SMG-SNU Boramae Medical Center) ;
  • Kim, Hak Jae (Department of Radiation Oncology, Seoul National University College of Medicine)
  • 투고 : 2017.04.17
  • 심사 : 2017.05.26
  • 발행 : 2017.06.30

초록

Purpose: The role of radiotherapy (RT) was largely deserted after the introduction of platinum-based chemotherapy, but still survival rates are disappointingly low. This study focuses on assessing the clinical efficacy of RT in relation to chemotherapy resistance. Materials and Methods: From October 2002 to January 2015, 44 patients were diagnosed with epithelial ovarian cancer (EOC) and treated with palliative RT for persistent or recurrent EOC. All patients received initial treatment with optimal debulking surgery and adjuvant platinum-based chemotherapy. The biologically effective dose (BED) was calculated with ${\alpha}/{\beta}$ set at 10. Ninety-four sites were treated with RT with a median BED of 50.7 Gy (range 28.0 to 79.2 Gy). The primary end-point was the in-field local control (LC) interval, defined as the time interval from the date RT was completed to the date any progressive or newly recurring disease within the RT field was detected on radiographic imaging. Results: The median follow-up duration was 52.3 months (range 7.7 to 179.0 months). The 1-year and 2-year in-field LC rates were 66.0% and 55.0%, respectively. Comparisons of percent change of in-field tumor response showed similar distribution of responses among chemoresistant and chemosensitive tumors. On multivariate analysis of predictive factors for in-field LC analyzed by sites treated, $BED{\geq}50Gy$ (hazard ratio, 0.4; confidence interval, 0.2-0.9; p = 0.025) showed better outcomes. Conclusion: Regardless of resistance to platinum-based chemotherapy, RT can be a feasible treatment modality for patients with persistent of recurrent EOC. The specific role of RT using updated approaches needs to be reassessed.

키워드

참고문헌

  1. Tinger A, Waldron T, Peluso N, et al. Effective palliative radiation therapy in advanced and recurrent ovarian carcinoma. Int J Radiat Oncol Biol Phys 2001;51:1256-63. https://doi.org/10.1016/S0360-3016(01)01733-3
  2. Patel SC, Frandsen J, Bhatia S, Gaffney D. Impact on survival with adjuvant radiotherapy for clear cell, mucinous, and endometriod ovarian cancer: the SEER experience from 2004 to 2011. J Gynecol Oncol 2016;27:e45. https://doi.org/10.3802/jgo.2016.27.e45
  3. Carey MS, Dembo AJ, Simm JE, Fyles AW, Treger T, Bush RS. Testing the validity of a prognostic classification in patients with surgically optimal ovarian carcinoma: a 15-year review. Int J Gynecol Cancer 1993;3:24-35. https://doi.org/10.1046/j.1525-1438.1993.03010024.x
  4. Skirnisdottir I, Nordqvist S, Sorbe B. Is adjuvant radiotherapy in early stages (FIGO I-II) of epithelial ovarian cancer a treatment of the past? Oncol Rep 2005;14:521-9.
  5. Sorbe B; Swedish-Norgewian Ovarian Cancer Study Group. 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. Int J Gynecol Cancer 2003;13:278-86. https://doi.org/10.1046/j.1525-1438.2003.13193.x
  6. Dembo AJ, Bush RS, Beale FA, et al. Ovarian carcinoma: improved survival following abdominopelvic irradiation in patients with a completed pelvic operation. Am J Obstet Gynecol 1979;134:793-800. https://doi.org/10.1016/0002-9378(79)90950-5
  7. Thomas G. Revisiting the role of radiation treatment for nonserous subtypes of epithelial ovarian cancer. Am Soc Clin Oncol Educ Book 2013 [Epub]. http://doi.org/10.1200/EdBook_AM.2013.33.e205.
  8. Cmelak AJ, Kapp DS. Long-term survival with whole abdominopelvic irradiation in platinum-refractory persistent or recurrent ovarian cancer. Gynecol Oncol 1997;65:453-60. https://doi.org/10.1006/gyno.1997.4696
  9. Wright JD, Chen L, Tergas AI, et al. Trends in relative survival for ovarian cancer from 1975 to 2011. Obstet Gynecol 2015;125:1345-52. https://doi.org/10.1097/AOG.0000000000000854
  10. Armstrong DK. Relapsed ovarian cancer: challenges and management strategies for a chronic disease. Oncologist 2002;7 Suppl 5:20-8.
  11. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: ovarian cancer including fallopian tube cancer and primary peritoneal cancer (version 1.2017) [Internet]. Fort Washington, PA: National Comprehensive Cancer Network; c2017 [cited 2017 April 17]. Available from: https://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
  12. Vergote I, Trope CG, Amant F, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363:943-53. https://doi.org/10.1056/NEJMoa0908806
  13. Ouldamer L, Bendifallah S, Chas M, et al. Intrinsic and extrinsic flaws of the nomogram predicting bone-only metastasis in women with early breast cancer: An external validation study. Eur J Cancer 2016;69:102-9. https://doi.org/10.1016/j.ejca.2016.09.039
  14. Horowitz NS, Miller A, Rungruang B, et al. Does aggressive surgery improve outcomes? Interaction between preoperative disease burden and complex surgery in patients with advanced-stage ovarian cancer: an analysis of GOG 182. J Clin Oncol 2015;33:937-43. https://doi.org/10.1200/JCO.2014.56.3106
  15. Mesko S, Sandler K, Cohen J, Konecny G, Steinberg M, Kamrava M. Clinical outcomes for stereotactic ablative radiotherapy in oligometastatic and oligoprogressive gynecological malignancies. Int J Gynecol Cancer 2017;27:403-8. https://doi.org/10.1097/IGC.0000000000000869
  16. Prat J; FIGO Committee on Gynecologic Oncology. FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum: abridged republication. J Gynecol Oncol 2015;26:87-9. https://doi.org/10.3802/jgo.2015.26.2.87
  17. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47. https://doi.org/10.1016/j.ejca.2008.10.026
  18. van Persijn van Meerten EL, Gelderblom H, Bloem JL. RECIST revised: implications for the radiologist: a review article on the modified RECIST guideline. Eur Radiol 2010;20:1456-67. https://doi.org/10.1007/s00330-009-1685-y
  19. Gelblum D, Mychalczak B, Almadrones L, Spriggs D, Barakat R. Palliative benefit of external-beam radiation in the management of platinum refractory epithelial ovarian carcinoma. Gynecol Oncol 1998;69:36-41. https://doi.org/10.1006/gyno.1998.4934
  20. Fuks Z, Rizel S, Biran S. Chemotherapeutic and surgical induction of pathological complete remission and whole abdominal irradiation for consolidation does not enhance the cure of stage III ovarian carcinoma. J Clin Oncol 1988;6:509-16. https://doi.org/10.1200/JCO.1988.6.3.509
  21. Louie KG, Behrens BC, Kinsella TJ, et al. Radiation survival parameters of antineoplastic drug-sensitive and -resistant human ovarian cancer cell lines and their modification by buthionine sulfoximine. Cancer Res 1985;45:2110-5.
  22. Corn BW, Lanciano RM, Boente M, Hunter WM, Ladazack J, Ozols RF. Recurrent ovarian cancer. Effective radiotherapeutic palliation after chemotherapy failure. Cancer 1994;74:2979-83. https://doi.org/10.1002/1097-0142(19941201)74:11<2979::AID-CNCR2820741114>3.0.CO;2-B
  23. Fujiwara K, Suzuki S, Yoden E, Ishikawa H, Imajo Y, Kohno I. Local radiation therapy for localized relapsed or refractory ovarian cancer patients with or without symptoms after chemotherapy. Int J Gynecol Cancer 2002;12:250-6. https://doi.org/10.1046/j.1525-1438.2002.01096.x
  24. Goff BA. Advanced ovarian cancer: what should be the standard of care? J Gynecol Oncol 2013;24:83-91. https://doi.org/10.3802/jgo.2013.24.1.83
  25. Chan JK, Teoh D, Hu JM, Shin JY, Osann K, Kapp DS. Do clear cell ovarian carcinomas have poorer prognosis compared to other epithelial cell types? A study of 1411 clear cell ovarian cancers. Gynecol Oncol 2008;109:370-6. https://doi.org/10.1016/j.ygyno.2008.02.006
  26. Swenerton KD, Santos JL, Gilks CB, et al. Histotype predicts the curative potential of radiotherapy: the example of ovarian cancers. Ann Oncol 2011;22:341-7. https://doi.org/10.1093/annonc/mdq383
  27. Bruzzone M, Repetto L, Chiara S, et al. Chemotherapy versus radiotherapy in the management of ovarian cancer patients with pathological complete response or minimal residual disease at second look. Gynecol Oncol 1990;38:392-5. https://doi.org/10.1016/0090-8258(90)90080-5
  28. Lee SW, Park SM, Kim YM, et al. Radiation therapy is a treatment to be considered for recurrent epithelial ovarian cancer after chemotherapy. Tumori 2011;97:590-5. https://doi.org/10.1177/030089161109700509
  29. Chundury A, Apicelli A, DeWees T, et al. Intensity modulated radiation therapy for recurrent ovarian cancer refractory to chemotherapy. Gynecol Oncol 2016;141:134-9.
  30. Brown AP, Jhingran A, Klopp AH, Schmeler KM, Ramirez PT, Eifel PJ. Involved-field radiation therapy for locoregionally recurrent ovarian cancer. Gynecol Oncol 2013;130:300-5. https://doi.org/10.1016/j.ygyno.2013.04.469
  31. Albuquerque K, Patel M, Liotta M, et al. Long-term benefit of tumor volume-directed involved field radiation therapy in the management of recurrent ovarian cancer. Int J Gynecol Cancer 2016;26:655-60. https://doi.org/10.1097/IGC.0000000000000653

피인용 문헌

  1. Radiotherapy for isolated recurrent epithelial ovarian cancer: A single institutional experience vol.45, pp.6, 2017, https://doi.org/10.1111/jog.13947
  2. Involved-field radiation therapy for selected cases of recurrent ovarian cancer vol.30, pp.5, 2017, https://doi.org/10.3802/jgo.2019.30.e67
  3. Clinical analysis of conformal and intensity-modulated radiotherapy in patients with recurrent ovarian cancer vol.10, pp.1, 2020, https://doi.org/10.1038/s41598-020-74356-7