Is adjuvant radiotherapy in early stages (FIGO I-II) of epithelial ovarian cancer a treatment of the past?

External abdomino-pelvic irradiation after primary surgery in early stages of epithelial ovarian carcinoma has been used as adjuvant therapy. The aims of this study were to evaluate efficacy and tolerability of abdomino-pelvic radiotherapy in ovarian carcinomas and to find predictive factors for recurrent disease. From January 1979 to December 1993, 215 patients with FIGO stage IA-IIC epithelial ovarian carcinoma were treated with postoperative radiotherapy. Whole-abdominal irradiation or lower abdomino-pelvic irradiation were 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 210 patients (98%). During the period of follow-up, 79 tumor recurrences (38%) were recorded. Abdomino-pelvic metastases were most frequent (22%). The overall 5-year and 10-year survival rate for the complete series was 60 and 41%, respectively. In a multivariate analysis, FIGO-stage, histopathological type and tumor grade were independent prognostic factors with recurrent-free survival as the end-point. Among the histopathological subtypes, the highest survival rate (80%) was found for the subgroup of 24 patients with clear cell carcinomas. Early radiation reactions of any type were noted in 85% of the cases. The incidence of severe late bowel toxicity was 12% and, in 11 patients (5%), surgery was necessary due to late radiation complications of the intestine. In conclusion, adjuvant abdomino-pelvic radiotherapy is a treatment option in early stages of ovarian carcinoma together with chemotherapy. However, further studies are needed to find the subgroup of patients who specifically might benefit from radiotherapy in this setting.