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Title: Long-term survival after surgery and radiotherapy for recurrent or persistent ovarian and tubal cancer
Epworth Authors: Rome, Robert
Leung, Samuel
Other Authors: Dipnall, Joanna
Keywords: Disease-Specific Survival
Recurrent Ovarian Cancer
Recurrent Tubal Cancer
Ovarian/Endometrial Carcinoma
Persistent Cancer
Second-Look Surgery
Long-Term Survival
Univariate Analysis
Initial Stage I
Initial Stage II
Initial Stage III
Initial Stage IV
Endometrioid History
Macroscopic Tumor
Localized Tumor
Widespread Tumor
Limited-Volume Radiotherapy Field
Multivariate Analysis
Bowel Complications
Increased Risk
Disease Management
Obstetrics and Gynaecology Clinical Institute, Epworth HealthCare, Victoria, Australia
Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
Epworth Radiation Oncology, Epworth HealthCare, Victoria, Australia
Issue Date: Jul-2018
Publisher: LWW
Citation: Int J Gynecol Cancer. 2018 Jul;28(6):1090-1100.
Abstract: 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.
DOI: 10.1097/IGC.0000000000001294
PubMed URL:
ISSN: 1048-891X
Journal Title: International Journal of Gynecological Cancer
Type: Journal Article
Affiliated Organisations: School of Medicine, Deakin University, Geelong
Radiation Oncology Victoria, Frankston, VIC, Australia
Epworth HealthCare, Richmond VIC, Australia
Type of Clinical Study or Trial: Case Series and Case Reports
Appears in Collections:Cancer Services
Radiation Oncology
Women's and Children's

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