Butala Anish A, Patel Roshal R, Manjunath Shwetha, Latif Nawar A, Haggerty Ashley F, Jones Joshua A, Taunk Neil K
Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Albany Medical College, Albany, New York.
Adv Radiat Oncol. 2020 Nov 25;6(1):100624. doi: 10.1016/j.adro.2020.11.009. eCollection 2021 Jan-Feb.
Metastatic, persistent, or recurrent epithelial ovarian cancer (MPR-EOC) remains a significant threat to patient mortality despite advances in novel targeted agents. Radiation therapy (RT) is often used as a palliative option. We report outcomes of a large series of MPR-EOC patients treated with modern palliative RT (PRT) in an era of novel systemic therapies.
A retrospective review was conducted of women treated with PRT for MPR-EOC between 2007 and 2019 at an academic institution. Clinical response rates were recorded at <1 month, 1 to 3 months, and >3 months. Radiographic responses were categorized by RECIST 1.1 criteria. Overall response rate (ORR) was the sum of complete and partial response. Linear regression analyses of baseline characteristics were conducted for statistical testing.
Eighty-six patients with PMR-OC received 120 courses of palliative RT. Median follow-up was 8.6 months. Median age was 61 (range, 22-82). Thirty-six percent of women received central nervous system (CNS)-directed RT. In addition, 43% received targeted therapies before RT. Clinical ORR within 1 month and at last follow-up for non-CNS lesions was 79% and 61% (69% and 88% for CNS lesions, respectively). High-grade serous lesions were more likely to have clinical response ( = .04). Biologically effective doses (BED) >39 Gy were associated with improved clinical response in CNS lesions ( = .049). Bony sites were associated with worse clinical ( = .004) response in non-CNS lesions compared with soft tissue or nodal sites. Acute or late grade 3+ toxicities with bevacizumab were low (8.7%/4.3%).
PRT offers excellent rates of response for symptomatic patients with MPR-EOC within 1 month of treatment, with durable responses beyond 3 months. High-grade serous lesions were associated with improved response in all patients. Higher BED and soft tissue or nodal sites were associated with improved response in CNS and non-CNS patients, respectively. Acute or late toxicities with bevacizumab and PRT were low. Prospective investigation is warranted to determine the optimal PRT regimen.
尽管新型靶向药物取得了进展，但转移性、持续性或复发性上皮性卵巢癌（MPR-EOC）仍然对患者死亡率构成重大威胁。放射治疗（RT）常被用作一种姑息治疗选择。我们报告了在新型全身治疗时代，一大系列接受现代姑息性放射治疗（PRT）的MPR-EOC患者的治疗结果。
对2007年至2019年在一家学术机构接受PRT治疗MPR-EOC的女性患者进行回顾性研究。在<1个月、1至3个月和>3个月时记录临床缓解率。根据RECIST 1.1标准对影像学缓解进行分类。总缓解率（ORR）为完全缓解和部分缓解的总和。对基线特征进行线性回归分析以进行统计检验。
86例PMR-OC患者接受了120疗程的姑息性放射治疗。中位随访时间为8.6个月。中位年龄为61岁（范围22-82岁）。36%的女性接受了针对中枢神经系统（CNS）的放射治疗。此外，43%的患者在放射治疗前接受了靶向治疗。1个月内及最后一次随访时非CNS病变的临床ORR分别为79%和61%（CNS病变分别为69%和88%）。高级别浆液性病变更有可能出现临床缓解（P = 0.04）。生物等效剂量（BED）>39 Gy与CNS病变临床缓解改善相关（P = 0.049）。与软组织或淋巴结部位相比，骨部位非CNS病变的临床缓解更差（P = 0.004）。贝伐单抗导致的急性或晚期3级及以上毒性较低（8.7%/4.3%）。
PRT为有症状的MPR-EOC患者在治疗1个月内提供了优异的缓解率，且3个月后缓解持久。高级别浆液性病变在所有患者中与缓解改善相关。较高的BED以及软组织或淋巴结部位分别与CNS和非CNS患者的缓解改善相关。贝伐单抗和PRT导致的急性或晚期毒性较低。有必要进行前瞻性研究以确定最佳的PRT方案。
