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Tytuł:
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Long-Term Survival After Surgery and Radiotherapy for Recurrent or Persistent Ovarian and Tubal Cancer.
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Autorzy:
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Rome R; Epworth HealthCare, Richmond.
Dipnall J; School of Medicine, Deakin University, Geelong.
Leung S
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Źródło:
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International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [Int J Gynecol Cancer] 2018 Jul; Vol. 28 (6), pp. 1090-1100.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2019- : [London] : BMJ
Original Publication: Cambridge, MA, USA : Blackwell Scientific Publications, c1991-
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MeSH Terms:
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Carcinoma, Ovarian Epithelial/*mortality
Carcinoma, Ovarian Epithelial/*therapy
Fallopian Tube Neoplasms/*mortality
Fallopian Tube Neoplasms/*therapy
Cancer Survivors ; Carcinoma, Ovarian Epithelial/radiotherapy ; Carcinoma, Ovarian Epithelial/surgery ; Cohort Studies ; Combined Modality Therapy ; Endometrial Neoplasms/mortality ; Endometrial Neoplasms/radiotherapy ; Endometrial Neoplasms/surgery ; Endometrial Neoplasms/therapy ; Fallopian Tube Neoplasms/radiotherapy ; Fallopian Tube Neoplasms/surgery ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/radiotherapy ; Neoplasm Recurrence, Local/surgery ; Neoplasm Recurrence, Local/therapy ; Neoplasm Staging ; Retrospective Studies ; Survivors ; Treatment Outcome
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Entry Date(s):
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Date Created: 20180531 Date Completed: 20190607 Latest Revision: 20190607
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Update Code:
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20240105
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DOI:
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10.1097/IGC.0000000000001294
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PMID:
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29846300
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Objective: This study examines the factors associated with long-term disease-specific survival (DSS) and complications after radiotherapy (RT) for recurrent or persistent ovarian and tubal cancer.
Methods/materials: Between 1980 and 2015, 65 women with ovarian (57), tubal (3), or co-existent ovarian/endometrial carcinoma (5) received RT (>45 Gy) with curative intent for recurrent (45) or persistent cancer (20) found at second-look surgery. Surgery to debulk (± restage) was integrated into the management of all but 7 cases.
Results: Twenty-two women had no evidence of disease at last contact after a median of 15.6 years (range = 1.0-35.8 years). Of the 53 patients treated more than 10 years ago, 18 (34%) are in this long-term no evidence of disease group. Univariate analysis showed that the following factors were significantly associated with longer DSS (P < 0.05): initial stage I, II (vs III, IV); endometrioid histology (vs serous and other); no or 1 previous chemotherapy (vs ≥2); no macroscopic tumor before RT (vs macroscopic); localized tumor encompassed by a limited-volume RT field (vs more widespread tumor), and chemotherapy and RT (vs RT only). Multivariate analysis showed that endometrioid (vs other histology HR = 4.37, P = 0.017) and localized tumor (vs more widespread tumor, HR = 2.43, P = 0.017) were significantly associated with longer DSS.After RT to the pelvis and/or abdomen, 13 (21.7%) of 60 patients developed G3 or 4 bowel complications requiring surgery. In 10, these occurred in the presence of tumor, RT changes, and adhesions, and in 3, there was no sign of cancer. Six patients (9.2%) developed a subsequent malignancy.
Conclusions: We conclude that there is a role for the use of RT in selected cases of localized recurrent or persistent ovarian cancer and may confer long-term survival. Surgery is useful to debulk and define the extent of tumor to be irradiated but may confer an increased risk of severe bowel complications.
