abstract: Low-Stage Ovarian Clear Cell Carcinoma: Population-Based Outcomes in British Columbia, Canada, With Evidence for a Survival Benefit As a Result of Irradiation

Low-Stage Ovarian Clear Cell Carcinoma: Population-Based Outcomes in British Columbia, Canada, With Evidence for a Survival Benefit As a Result of Irradiation

 Abstract

Purpose 

To evaluate the population-based outcomes of stage I and II ovarian clear cell carcinoma (OCCC) in a North American population treated with carboplatin/paclitaxel and abdominopelvic irradiation.

Patients and Methods 

Retrospective analysis was performed of 241 patients referred in the carboplatin/paclitaxel era. Irradiation was to be used with a few defined exceptions. However, because of differing beliefs as to its effectiveness, its use was consistently avoided by specific oncologists, allowing the opportunity to study its possible effect on disease-free survival (DFS) in these concurrent cohorts. 

Results 

Five- and 10-year DFS rates were 84% and 70% for stage IA/B; 67% and 57% for stage IC; and 49% and 44% for stage II, respectively. 

Five- and 10-year DFS rates for those with stage IC disease based purely on rupture were similar to rates for patients with stage IA/B, at 92% and 71%, respectively. 

The remaining patients with stage IC had 48% 5- and 10-year DFS. 

 Multivariate analysis using a decision tree identified positive cytology as the most important factor (72% relapse rate if positive and 27% if negative or unknown). 

If, in addition, the capsule surface was involved, then the relapse rate was 93%. Irradiation had no discernible survival benefit for patients with stage IA and IC (rupture alone), whereas for the remainder of patients with stage IC and stage II, it improved DFS by 20% at 5 years (relative risk, 0.5); the benefit was most evident in the cytologically negative/unknown group. 

Conclusion 

DFS is similar in this North American population with early OCCC to the DFS reported in Asia. A potential benefit from irradiation was evident in a subset.

abstract: Role of Definitive Radiation Therapy in Carcinoma of Unknown Primary in the Abdomen and Pelvis

Role of Definitive Radiation Therapy in Carcinoma of Unknown Primary in the Abdomen and Pelvis

 Objectives

Carcinoma of unknown primary (CUP) in the abdomen and pelvis is a heterogeneous group of cancers with no standard treatment. Considered by many to be incurable, these patients are often treated with chemotherapy alone. In this study, we determined the effectiveness of radiation therapy in combination with chemotherapy in patients with CUP in the abdomen and pelvis.

Patients and Methods

Medical records were reviewed for 37 patients with CUP treated with radiation therapy for disease located in the soft tissues and/or nodal basins of the abdomen and pelvis at the University of Texas M.D. Anderson Cancer between 2002 and 2009. All patients underwent chemotherapy, either before or concurrent with radiation therapy. Patients were selected for radiation therapy on the basis of histologic type, disease extent, and prior therapy response. Twenty patients underwent definitive radiation therapy (defined as radiation therapy targeting all known disease sites with at least 45 Gy) and 17 patients underwent palliative radiation therapy. Only 6 patients had surgical resection of their disease. Patient and treatment characteristics were extracted and the endpoints of local disease control, progression-free survival (PFS), overall survival (OS), and treatment-related toxicity incidence were analyzed.

Results

The 2-year PFS and OS rates for the entire cohort were 32% and 57%, respectively. However, in patients treated with definitive radiation therapy, the rates were 48% and 76%, and 7 patients lived more than 3 years after treatment with no evidence of disease progression. Nevertheless, radiation-associated toxicity was significant in this cohort, as 40% experienced Grade 2 or higher late toxicities.

Conclusions

The use of definitive radiation therapy should be considered in selected patients with CUP in the soft tissues or nodal basins of the abdomen and pelvis.

Carcinoma of unknown primary, Chemoradiation, Conformal radiation therapy, Intensity-modulated radiation therapy, Lymph node metastasis

open access: Intraoperative radiotherapy electron boost in advanced and recurrent epithelial ovarian carcinoma: a retrospective study - 45 pts

Blogger's Note: interesting study worth reading

Background

The aim of this study was to evaluate the clinical outcome and toxicity of intraoperative electron beam radiation therapy (IOERT) in advanced and recurrent EOC.

Conclusions

IOERT may be feasible and effective as a boosting technique for advanced and recurrent ovarian cancer. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. Peripheral nerves in the IOERT field are dose-limiting structures requiring nerve protection policies or a dose compromise to ensure against severe neurological damage.

Patients

This study was a non-randomized trial and included retrospective analysis of 45 women with EOC who were treated with IOERT at the 1st Affiliated Hospital of the Medical College of Xi'an Jiaotong University between January 2000 and January 2010.........The mean follow-up time was 78 months (range: 11-123 months).........

Table 1

Patient Characteristics

	Total	PD	ILR
Cases	45	25	20
Histology type
serous adenocarcinoma	36	21	16
papillary adenocarcinoma	9	4	4
CA-125 level
≥ 35 U/ml	38	20	18
< 35 U/ml	4	3	1
unknown	3	2	1

Conclusions
IOERT may be feasible and effective as a boosting technique to treat advanced and recurrent ovarian cancers. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. However, careful attention should be paid to peripheral nerves as specific IOERT dose-limiting structures.

full free access: Histotype predicts the curative potential of radiotherapy: the example of ovarian cancers — Ann Oncol (stage/cell type)

Note: tables for survival data (longterm) eg. cell types

"....The Gynecology Tumour Group of our institution has elected to continue to advise the use of CRT in women with stage Ic and II endometrioid and mucinous lesions, and all stage I and II clear cell disease, on the basis of these data and a recently published analysis of histotype-specific outcomes [32]. However, RT will be targeted to the pelvis, with consideration of extending the field to include paraaortic nodes if stage IIc (given the higher rate of occult nodal involvement reported for this stage [26]). RT will be dropped from our prescription for those with serous tumors.

Our findings also bring into question the nonselective surgical and CT approaches that have characterized ovarian cancer care and are of potential clinical importance for those with other tumors, which have been collectively defined by presumed organ of origin rather than underlying biological features"

abstract: Whole abdominopelvic radiotherapy using intensity-modulated arc therapy in the palliative treatment of chemotherapy-resistant ovarian cancer with bulky peritoneal disease

CONCLUSION: WAPRT delivered using intensity-modulated arc therapy offers important palliation in the case of peritoneal metastatic ovarian cancer. WAPRT resolved intestinal obstruction for a substantial period.

abstract: Role of adjuvant radiotherapy in granulosa cell tumors of the ovary

PURPOSE: To review the role of adjuvant radiotherapy (RT) in the outcome and recurrence patterns of granulosa cell tumors (GCTs) of the ovary.

CONCLUSION: Ovarian GCTs can be indolent, with patients achieving long-term survival. In our series, adjuvant RT resulted in a significantly longer DFS. Ideally, randomized trials with long-term follow-up are needed to define the role of adjuvant RT for ovarian GCTs.

Radiation Therapy for Cancer - National Cancer Institute

Note: lists different forms of radiation therapy

Alarming Pattern Identified for Bone Metastases (not specific to ovarian cancer)