Stage II invasive adenocarcinoma of the ovary: results of treatment by whole abdominal radiation plus pelvic boost versus pelvic radiation plus oral melphalan chemotherapy.

Thirty-one patients with histologically confirmed FIGO Stage II adenocarcinoma of the ovary were prospectively treated in two sequential studies: 3000 rad of whole abdominal radiation therapy over 6 weeks by an open field technique followed by 2000 rad pelvic boost over 2 weeks (group 1, 16 patients, 1972-1974) or 5000 rad of pelvic radiation therapy over 5 weeks followed by a year of melphalan chemotherapy at a dose of 0.2 mg/kg/day for 5 days every 4 weeks (group 2, 15 patients, 1975-1982). Abdominal radiation included the entire peritoneal cavity and both diaphragms; the liver was not shielded. Only 2 patients had residual disease greater than 2 cm. No group 1 patients underwent pretherapy restaging laparoscopy prior to radiation or second look laparotomy after treatment. Eighty percent of group 2 patients underwent restaging laparoscopy (10) or staging laparotomy (2) prior to radiation. All group 2 patients underwent second look procedures if no evidence of disease. No patient developed intestinal complications secondary to radiation requiring surgery. Eighty-one percent of group 1 patients and to date 40% of group 2 patients developed recurrences. Size of residual disease prior to radiation, histologic grade, and substage (IIA, B, or C) did not correlate with recurrences. Five-year estimated survival was 40 and 50% for groups 1 and 2, respectively. Three thousand rad of wole abdominal radiation plus 2000 rad pelvic boost or 5000 rad pelvic radiation plus melphalan did not appear to improve survival over surgery alone. The role of radiation therapy in Stage II ovarian cancer remains unclear.