Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
Int J Radiat Oncol Biol Phys. 2010 Apr;76(5):1382-9. doi: 10.1016/j.ijrobp.2009.03.061. Epub 2009 Jul 21.
To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer.
Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones.
Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients.
The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.
评估手术和化疗后强化调强全腹部放疗（WAR）在高危晚期卵巢癌患者中的可行性和毒性。
10 例国际妇产科联合会（FIGO）分期 IIIc 期卵巢癌患者在一项 I 期研究中接受了强化调强 WAR 治疗，在辅助卡铂/紫杉烷化疗后作为巩固治疗，总剂量为 30 Gy，分为 1.5 Gy 的分数。治疗采用强度调制放疗的步进和射击技术（n = 3）或螺旋断层放疗技术（n = 7）。计划靶区包括整个腹腔和盆腔及主动脉旁淋巴结区。危及器官为肾脏、肝脏、心脏、椎体和骨盆骨。
强化调强 WAR 实现了计划靶区的优异覆盖和对危及器官的有效保护。治疗耐受性良好，无严重 4 级急性不良反应。常见毒性标准 3 级毒性如下：腹泻（n = 1）、血小板减少症（n = 1）和白细胞减少症（n = 3）。所有患者均能完成放疗，无任何与毒性相关的中断。中位随访时间为 23 个月，4 例患者出现肿瘤复发（腹腔内进展，n = 3；肝转移，n = 1）。3 例患者因粘连导致小肠梗阻。
这项 I 期研究的结果首次表明，强化调强全腹部放疗在临床是可行的，为辅助化疗后选择的晚期卵巢癌患者的巩固治疗提供了一种新的治疗选择。我们启动了一项 II 期研究，以进一步评估这种强化多模式治疗的毒性。
