Is there a role for consolidation or salvage radiotherapy after chemotherapy in advanced epithelial ovarian cancer?

Cure rates following surgery and platinum-containing chemotherapy in advanced epithelial ovarian cancer are only 20-30%. Relapse rates even after complete chemotherapy responses or those leaving only microscopic residual disease are disappointingly high at 30 to 80%. Strategies to improve outcome, consolidate the results of surgery and chemotherapy, or salvage those with residual disease include whole-abdominopelvic irradiation. This paper reviews its usage to date in 28 trials. The results of sequential therapy are generally disappointing, possibly because of inappropriate patient selection, toxic regimens, underlying biological factors, and difficulties interpreting the uncontrolled studies. Tumor residuum appears to be one factor predictive of survival: no residuum, 76%; microscopic or < 5 mm, 49%; macroscopic, 17%. Other factors may be tumor grade and patient age. Appropriate selection of patients for controlled studies of sequential radiotherapy after surgery and chemotherapy include those with negative second-look laparotomy who had large residual Stage III presentations prechemotherapy, are over 50 years of age, or who have grade 3 tumors. Others are those with microscopic residual disease, grade 1 or 2. If therapy is to be successfully completed with minimal morbidity, abdominal radiotherapy should be limited to < or = 25 Gy, initial chemotherapy to six courses, and surgery to initial debulking and second-look laparotomy.