The Department of Radiotherapy Oncology in the 1st Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an, 710061, China.
BMC Cancer. 2011 Oct 11;11:439. doi: 10.1186/1471-2407-11-439.
Relapses of epithelial ovarian carcinoma (EOC) have a poor prognosis and are almost always fatal. The aim of this study was to evaluate the clinical outcome and toxicity of intraoperative electron beam radiation therapy (IOERT) in advanced and recurrent EOC.
Forty-five women with EOC were treated with IOERT. Twenty-five patients had primary disease (PD) without distant metastasis at IOERT, and 20 patients had an isolated local recurrence (ILR) after surgery. All 45 patients in this series underwent optimal cytoreductive (≤ 1 cm) surgery. The whole pelvic (WP) radiotherapy was intraoperatively delivered using 12 Mev electron beam; 43 patients received 18-20 Gy and two patients received 10 Gy. Thirty-three patients received postoperateive intraperitoneal (IP) chemotherapy, while seven patients received intravenous (IV) chemotherapy. Five patients refused concurrent chemotherapy. Overall survival (OS) rates were analyzed using the Kaplan-Meier method.
Tumor recurrence and metastasis were observed in 16 patients (35.6%). Of those, 14 patients (31.1%) relapsed and two patients (4.4%) had distant metastasis alone. Eight of 25 (32%) local failures were observed in the PD group, as compared to 6/20 (30%) in the ILR group (P = 0.885). Actuarial local control at five year follow-up was 31/45 (68.9%). Seventeen of the total 45 (37.8%) patients died. Nine of 25 (36%) in the PD group died, as compared to 8 of 20 (40%) in the ILR group. The 5-year OS and disease-free survival (DFS) rates were 28/45 (62.2%) and 25/45 (55.6%), respectively. In the PD group, the 5-year OS and DFS rates were 16/25 (64%) and 14/25 (56%) (P > 0.05, vs. the ILR group at 12/20 and 11/20, respectively). The OS and DFS in the IOERT plus IP group were 25/33 (75.8%) and 23/33 (69.7%), respectively, which were superior to the rates achieved with IOERT plus IV chemotherapy (P < 0.05, 2/7 and 1/7, respectively). The major complication of IOERT was neuropathy. Five (11.1%) patients developed peripheral neurotoxicity.
IOERT may be feasible and effective as a boosting technique for advanced and recurrent ovarian cancer. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. Peripheral nerves in the IOERT field are dose-limiting structures requiring nerve protection policies or a dose compromise to ensure against severe neurological damage.
上皮性卵巢癌（EOC）的复发预后较差，几乎总是致命的。本研究旨在评估术中电子束放疗（IOERT）在晚期和复发性 EOC 中的临床结果和毒性。
45 名患有 EOC 的女性接受了 IOERT 治疗。25 名患者在 IOERT 时患有原发性疾病（PD）且无远处转移，20 名患者在手术后出现孤立性局部复发（ILR）。本系列中所有 45 名患者均接受了最佳减瘤（≤1cm）手术。全盆腔（WP）放疗在术中使用 12Mev 电子束进行；43 名患者接受 18-20Gy，2 名患者接受 10Gy。33 名患者接受术后腹腔内（IP）化疗，7 名患者接受静脉（IV）化疗。5 名患者拒绝同时接受化疗。使用 Kaplan-Meier 方法分析总生存期（OS）率。
16 名患者（35.6%）出现肿瘤复发和转移。其中，14 名患者（31.1%）复发，2 名患者（4.4%）仅有远处转移。25 名 PD 组中有 8 名（32%）发生局部失败，20 名 ILR 组中有 6 名（30%）（P=0.885）。5 年随访时的局部控制率为 31/45（68.9%）。总共有 45 名患者中的 17 名（37.8%）死亡。25 名 PD 组中有 9 名（36%）死亡，20 名 ILR 组中有 8 名（40%）死亡。45 名患者的 5 年 OS 和无病生存率（DFS）分别为 28/45（62.2%）和 25/45（55.6%）。在 PD 组中，5 年 OS 和 DFS 率分别为 16/25（64%）和 14/25（56%）（P>0.05，与 ILR 组的 12/20 和 11/20 相比）。IOERT+IP 组的 OS 和 DFS 分别为 25/33（75.8%）和 23/33（69.7%），优于 IOERT+IV 化疗组（P<0.05，分别为 2/7 和 1/7）。IOERT 的主要并发症是神经病变。5 名（11.1%）患者出现周围神经毒性。
IOERT 作为晚期和复发性卵巢癌的辅助治疗方法可能是可行和有效的。IOERT+IP 化疗可能通过低毒性获得高局部疾病控制和生存获益。IOERT 治疗区域的周围神经是限制剂量的结构，需要神经保护策略或剂量妥协，以防止严重的神经损伤。
