Adjuvant radiotherapy in stage I-II epithelial ovarian cancer

The purpose of this study was to assess the efficacy and side-effects of abdominopelvic irradiation applied as adjuvant postoperative therapy in early stage ovarian carcinomas.

From 1 January 1988 to 31 December 1993, 113 patients with FIGO stage IA-IIC epithelial ovarian carcinoma were treated with postoperative radiotherapy. Whole abdominal irradiation or lower abdominopelvic irradiation was used. The dose of specification was 20 Gy to the upper part of the abdominal cavity and 40 Gy to the lower part of the abdomen and the pelvic region.

Primary cure was achieved in 110 patients (97%). During the period of follow-up, 33 cases of tumor recurrences (30%) were recorded. Abdominopelvic metastases were most frequent (18%). The overall 5-year survival rate for the complete series was 69% and the cancer-specific survival rate was 72%. Tumor grade was an independent and significant prognostic factor (Cox multivariate analysis; p = 0.007). Early radiation reactions of any type were noted in 93% of the cases and, in 11%, discontinuation of radiotherapy was necessary. Late radiation reactions were noted in 58% of the cases and the most common side-effect was diarrhea, but in most cases these reactions were of limited clinical significance. The incidence of severe bowel toxicity was 10% and, in two patients ( 1.8%), surgery was necessary due to late radiation reactions.

Adjuvant abdominopelvic radiotherapy is one option among others (e.g. various types of chemotherapy or no further treatment) in primary treatment of early stage ovarian carcinoma. The optimal adjuvant therapy for this group of patients is not known today and further prospective and randomized studies are needed.