Kuten A, Stein M, Steiner M, Rubinov R, Epelbaum R, Cohen Y
Northern Israel Oncology Center, Rambam Medical Center, Haifa, Israel.
Int J Radiat Oncol Biol Phys. 1988 Feb;14(2):273-9. doi: 10.1016/0360-3016(88)90432-4.
One hundred and sixteen patients with advanced ovarian carcinoma, who underwent primary cytoreductive surgery, received 6-11 courses of chemotherapy by cis-platin (50 mg/m2) and adriamycin (50 mg/m2) every 21 days. This was followed by second look laparotomy in 66 patients with no clinical evidence of disease. Consolidation abdominal irradiation was administered to 43 patients. Two techniques of irradiation were employed: between 1980-1983 whole abdominal irradiation was used and patients were to receive 3000 cGy in 4 weeks (Schedule I). Due to myelosuppression only 13 of 26 patients (50%) completed the planned dose of radiation. Between 1983-1985 the target volume was divided into upper and lower parts. First, the lower abdomen received 3000 cGy in 3 weeks, and then the upper abdomen received the same dose (Schedule II). Sixteen of seventeen patients (94%) thus treated, completed the planned dose of radiation. The actuarial survival for all 116 patients was 28% of 5 years. Irradiated patients with negative second look laparotomy had a survival probability of 100% at 24 months. Irradiated patients with microscopic disease at second look operation had an actuarial 5-year survival of 66%. Patients with minimal residual disease at second look laparotomy, receiving consolidation abdominal irradiation, had an actuarial survival of 5% only at 36 months. It is concluded that consolidation radiotherapy is effective in patients with negative or microscopic residual disease at second-look laparotomy. In regard to bone marrow tolerance, split field technique of irradiation is preferred.
116例晚期卵巢癌患者接受了初次肿瘤细胞减灭术，每21天接受6 - 11个疗程的顺铂（50mg/m²）和阿霉素（50mg/m²）化疗。之后，66例无疾病临床证据的患者接受了二次探查剖腹术。43例患者接受了巩固性腹部放疗。采用了两种放疗技术：1980年至1983年期间使用全腹放疗，患者需在4周内接受3000cGy（方案I）。由于骨髓抑制，26例患者中只有13例（50%）完成了计划的放疗剂量。1983年至1985年期间，靶区分为上下两部分。首先，下腹部在3周内接受3000cGy，然后上腹部接受相同剂量（方案II）。接受如此治疗的17例患者中有16例（94%）完成了计划的放疗剂量。所有116例患者的5年精算生存率为28%。二次探查剖腹术结果为阴性的放疗患者24个月时的生存概率为100%。二次探查手术时有微小病灶的放疗患者5年精算生存率为66%。二次探查剖腹术时残留病灶最小且接受巩固性腹部放疗的患者36个月时的精算生存率仅为5%。结论是，巩固性放疗对二次探查剖腹术时残留病灶为阴性或微小的患者有效。就骨髓耐受性而言，分割野放疗技术更佳。
