Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
J Gynecol Oncol. 2019 Sep;30(5):e67. doi: 10.3802/jgo.2019.30.e67.
In our institutional experience, involved-field radiation therapy (IFRT) yields favorable outcomes in patients with recurrent epithelial ovarian cancer (EOC). This retrospective study aimed to investigate the clinical benefits of IFRT in this patient population.
Among patients treated with IFRT for recurrent EOC between 2010 and 2017, 61 patients with 90 treatments were included. IFRT encompassed all treatable lesions identified via imaging studies with 10-15-mm margins. Prescribed doses were ≥45 Gy (equivalent dose in 2 Gy/fraction).
Patients were followed up for a median of 19.0 (Interquartile range, 8.6-34.9) months after IFRT. The 2-year in-field control, progression-free survival, and overall survival (OS) rates were 42.7%, 24.2%, and 78.9%, respectively. Fifty-three IFRT sessions (58.9%) were followed by systemic chemotherapy, and the median chemotherapy-free interval (CFI) was 10.5 (95% confidence interval=7.3-13.7) months. A higher carbohydrate antigen-125 (CA-125) level correlated with a worse 2-year OS (69.2% vs. 91.0%; p=0.001) and shorter median CFI (4.7 vs. 11.9 months; p<0.001). Twenty-eight (31.1%) of 90 treatments yielded a long-term CFI >12 months. For patients with a normal CA-125 level and/or platinum-sensitive tumor, IFRT prolonged CFI regardless of pre-existing carcinomatosis, gross tumor volume, and number of treatment sites.
Our early experience demonstrates the safety and feasibility of IFRT as an effective salvage therapy and enables a "chemotherapy holiday" in selected recurrent EOC settings. The CA-125 value before IFRT (within normal range) and/or platinum sensitivity could be used as selection criteria for IFRT.
在我们的机构经验中，累及野放疗（IFRT）在复发性上皮性卵巢癌（EOC）患者中产生了良好的结果。本回顾性研究旨在调查 IFRT 在这一患者群体中的临床获益。
在 2010 年至 2017 年间接受 IFRT 治疗复发性 EOC 的患者中，纳入了 61 例患者的 90 次治疗。IFRT 包括通过影像学研究确定的所有可治疗病变，边界为 10-15mm。处方剂量≥45Gy（等效剂量为 2Gy/分次）。
患者在 IFRT 后中位随访 19.0（四分位距，8.6-34.9）个月。2 年的瘤内控制率、无进展生存率和总生存率（OS）分别为 42.7%、24.2%和 78.9%。53 次 IFRT 治疗（58.9%）后进行了全身化疗，中位化疗无进展间隔（CFI）为 10.5（95%置信区间=7.3-13.7）个月。较高的糖链抗原 125（CA-125）水平与较差的 2 年 OS（69.2%vs.91.0%；p=0.001）和较短的中位 CFI（4.7vs.11.9 个月；p<0.001）相关。90 次治疗中有 28 次（31.1%）的长期 CFI>12 个月。对于 CA-125 水平正常和/或铂敏感肿瘤的患者，IFRT 延长了 CFI，无论是否存在预先存在的癌转移、大体肿瘤体积和治疗部位数量。
我们的早期经验表明，IFRT 作为一种有效的挽救性治疗是安全可行的，并使选定的复发性 EOC 环境能够“化疗休假”。IFRT 前的 CA-125 值（在正常范围内）和/或铂敏感性可用作 IFRT 的选择标准。
