Franchin G, Tumolo S, Scarabelli C, De Paoli A, Boz G, Crivellari D, Arcicasa M, Bortolus R, Gobitti C, Minatel E
Radiotherapy Department, Centro di Riferimento Oncologico, Aviano, (Pordenone), Italy.
Gynecol Oncol. 1991 Jun;41(3):206-11. doi: 10.1016/0090-8258(91)90309-s.
From April 1983 through December 1989, 42 consecutive patients with diagnosis of epithelial ovarian carcinoma were initially managed by aggressive surgery and three courses of endoperitoneal cis-platinum-based chemotherapy followed by an alternating combination chemotherapy and second-look laparotomy. Patients with residual tumor less than or equal to 2 cm subsequently received whole abdominal radiation therapy (WAR). Twenty-eight patients (42% with no residual disease, 21% with microscopic disease, and 36% with residual disease less than 2 cm) were eligible for WAR. WAR was delivered using an open-field technique up to 22 Gy in 20 fractions followed by a pelvic boost of 18 Gy in 10 fractions. The kidneys were shielded posteriorly at 1100 cGy; hepatic shields were not added. One patient did not complete WAR for lung metastases after 5 radiotherapy fractions. The complete treatment program lasted 8 months (range, 6.8-11). The median follow-up of the 28 patients entered into the study was 50 months. Eight patients are alive and disease-free at 5 years. The overall and disease-free survival rates at 5 years are 45 and 30%, respectively. All but 2 patients relapsed within the abdominopelvic cavity and 3 developed brain metastases. Toxic effects, during WAR, required treatment interruption in all but 4 patients: 3 developed a small bowel obstruction requiring surgery and 1 died of surgical complications in complete remission. The poor disease-free survival and the severe toxicity encountered have been valid indications that WAR should be discontinued as a treatment modality in advanced ovarian cancer at our department.
从1983年4月至1989年12月，42例经诊断为上皮性卵巢癌的连续患者最初接受了根治性手术和三个疗程的腹腔内顺铂为主的化疗，随后进行交替联合化疗和二次探查剖腹术。残留肿瘤小于或等于2 cm的患者随后接受全腹放射治疗（WAR）。28例患者（无残留疾病者占42%，微小疾病者占21%，残留疾病小于2 cm者占36%）符合WAR条件。WAR采用开放野技术，分20次给予22 Gy，随后盆腔加量10次给予18 Gy。肾脏在后方屏蔽至1100 cGy；未加肝脏屏蔽。1例患者在放疗5次后因肺转移未完成WAR。完整的治疗方案持续8个月（范围6.8 - 11个月）。纳入该研究的28例患者的中位随访时间为50个月。8例患者5年时存活且无疾病。5年时的总生存率和无病生存率分别为45%和30%。除2例患者外，所有患者均在腹腔盆腔内复发，3例发生脑转移。在WAR期间，除4例患者外，所有患者均因毒性反应需要中断治疗：3例发生小肠梗阻需要手术，1例在完全缓解期死于手术并发症。无病生存率低以及出现严重毒性反应已成为在我们科室应停止将WAR作为晚期卵巢癌治疗方式的有效指征。
