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Matsunaga S, Shuto T, Serizawa T, Aoyagi K, Hasegawa T, Kawagishi J, Yomo S, Kenai H, Nakazaki K, Moriki A, Iwai Y, Yamamoto T. Gamma Knife radiosurgery for metastatic brain tumors from ovarian cancer: histopathological analysis of survival and local control. A Japanese multi-institutional cooperative and retrospective cohort study. J Neurosurg 2022; 137:1006-1014. [PMID: 35148503 DOI: 10.3171/2021.12.jns212239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Brain metastasis is rare in ovarian cancer patients. The results of Gamma Knife radiosurgery (GKRS) for the treatment of patients with brain metastases from ovarian cancer were retrospectively analyzed to derive the efficacy and prognostic factors for survival and local tumor control. Further histopathological analysis was also performed. METHODS The authors retrospectively reviewed the medical records of 118 patients with 566 tumors who had undergone GKRS at the 10 GKRS institutions in Japan. RESULTS After the initial GKRS, the median overall survival time was 18.1 months. Multivariate analysis showed that uncontrolled primary cancer (p = 0.003) and multiple intracranial metastases (p = 0.034) were significant unfavorable factors. Ten patients died of uncontrolled brain metastases at a median of 17.1 months. The 6-, 12-, and 24-month neurological death rates were 3.2%, 4.6%, and 11.9%, respectively. The 6-, 12-, and 24-month neurological deterioration rates were 7.2%, 13.5%, and 31.4%, respectively. The 6-, 12-, and 24-month distant brain control failure rates were 20.6%, 40.2%, and 42.3%, respectively. Median tumor volume was 1.6 cm3 and marginal dose was 20 Gy. The 6-, 12-, and 24-month local tumor control rates were 97.6%, 95.2%, and 88.0%, respectively. Peritumoral edema (p = 0.043), more than 7-cm3 volume (p = 0.021), and prescription dose less than 18 Gy (p = 0.014) were factors that were significantly correlated in local tumor control failure. Eight patients had symptomatic radiation injury. The 6-, 12-, and 24-month GKRS-related complication rates were 3.3%, 7.8%, and 12.2%, respectively. Primary ovarian cancer was histopathologically diagnosed for 313 tumors in 69 patients. Serous adenocarcinoma was found in 37 patients and other types in 32 patients. Median survival times were 32.3 months for the serous type and 17.4 months for other types after initial GKRS. Patients with serous-type tumors survived significantly longer than patients with other types (p = 0.039). The 6-, 12-, and 24-month local tumor control rates were 100%, 98.8%, and 98.8%, respectively. Serous-type tumors were a significantly good prognosis factor for local tumor control after GKRS (p = 0.005). CONCLUSIONS This study established a relationship between the efficacy of GKRS treatment for brain metastases and the histological type of primary ovarian cancer. GKRS for ovarian cancer brain metastasis can provide satisfactory survival and local control, especially in cases of serous adenocarcinoma.
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Affiliation(s)
- Shigeo Matsunaga
- 1Department of Neurosurgery and
- 2Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama, Kanagawa
| | - Takashi Shuto
- 1Department of Neurosurgery and
- 2Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama, Kanagawa
| | - Toru Serizawa
- 3Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo
| | - Kyoko Aoyagi
- 4Department of Neurosurgery, Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba
| | - Toshinori Hasegawa
- 5Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Aichi
| | - Jun Kawagishi
- 6Department of Neurosurgery, Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Miyagi
| | - Shoji Yomo
- 7Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Nagano
| | - Hiroyuki Kenai
- 8Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita
| | - Kiyoshi Nakazaki
- 9Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima
| | | | - Yoshiyasu Iwai
- 11Department of Neurosurgery, Osaka City General Hospital, Osaka; and
| | - Tetsuya Yamamoto
- 12Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Yang H, Zhang K, Liu Z, Wang T, Shi F, Su J, Zhang J, Liu J, Dai L. Clinical analysis of conformal and intensity-modulated radiotherapy in patients with recurrent ovarian cancer. Sci Rep 2020; 10:17172. [PMID: 33057094 PMCID: PMC7560837 DOI: 10.1038/s41598-020-74356-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/23/2020] [Indexed: 11/09/2022] Open
Abstract
We aimed to provide evidence for radiotherapy treatment regimens in patients with clinically recurrent ovarian cancer. We analyzed the survival and prognostic factors in 43 patients who were treated for recurrent ovarian cancer at 58 tumor sites using three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) during January 2006-December 2017. t years 1, 2, and 3, overall survival (OS) rate was 82.4%, 68.4%, and 57.9%; local control (LC) rate was 100%, 100% and 80%; recurrence free survival (RFS) rate was 86.8%, 66.6%, and 61.1%; and disease-free survival (DFS) rate was 79.7%, 56.7%, and 46.8%, respectively. The radiotherapy technique was determined to be an independent prognostic factor for survival; the survival rate of patients was significantly improved with IMRT compared to 3D-CRT (P = 0.035). Radiotherapy dose was an independent prognostic factor; survival rate improved when patients were treated with a radiation dose ≥ 60 Gy as compared to < 60 Gy (P = 0.046). Elective nodal prophylactic radiation therapy (ENRT) did not lead to a significant improvement in survival when compared to involved-field radiation therapy (IFRT). The toxicities of 3D-CRT and IMRT were tolerable. One patient (2.3%) had grade 3 acute gastrointestinal (GI) toxicity, 2 (4.6%) grade 3 late GI toxicity, 5 (11.6%) grade 3 hematological toxicity, and 2 (4.6%) had grade 4 hematological toxicity. IMRT improved LC and OS in patients with recurrent ovarian cancer after surgery and multiple chemotherapy; toxicities were tolerable. The IMRT technique and radiotherapy dose of ≥ 60 Gy had independent prognostic significance for the survival of such patients.
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Affiliation(s)
- Hua Yang
- Department of Radiotherapy, Xijing Hospital of Air Force Military Medical University (the Fourth Military Medical University), Xi'an, Shaan'xi, China
| | - Kaishuo Zhang
- Department of Radiotherapy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan'xi, China
| | - Zi Liu
- Department of Radiotherapy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan'xi, China.
| | - Tao Wang
- Department of Radiotherapy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan'xi, China
| | - Fan Shi
- Department of Radiotherapy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan'xi, China
| | - Jin Su
- Department of Radiotherapy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan'xi, China
| | - Jintao Zhang
- Department of Radiotherapy, Xi'an Gao Xin Hospital, Xi'an, Shaan'xi, China
| | - Juanyue Liu
- Department of Radiotherapy, Xi'an Gao Xin Hospital, Xi'an, Shaan'xi, China
| | - Li Dai
- Department of Radiotherapy, Xi'an Gao Xin Hospital, Xi'an, Shaan'xi, China
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Chuang YC, Chu CH, Cheng SH, Liao LD, Chu TS, Chen NT, Paldino A, Hsia Y, Chen CT, Lo LW. Annealing-modulated nanoscintillators for nonconventional X-ray activation of comprehensive photodynamic effects in deep cancer theranostics. Theranostics 2020; 10:6758-6773. [PMID: 32550902 PMCID: PMC7295068 DOI: 10.7150/thno.41752] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/04/2020] [Indexed: 01/10/2023] Open
Abstract
Photodynamic therapy (PDT), which involves the generation of reactive oxygen species (ROS) through interactions of a photosensitizer (PS) with light and oxygen, has been applied in oncology. Over the years, PDT techniques have been developed for the treatment of deep-seated cancers. However, (1) the tissue penetration limitation of excitation photon, (2) suppressed efficiency of PS due to multiple energy transfers, and (3) insufficient oxygen source in hypoxic tumor microenvironment still constitute major challenges facing the clinical application of PDT for achieving effective treatment. We present herein a PS-independent, ionizing radiation-induced PDT agent composed of yttrium oxide nanoscintillators core and silica shell (Y2O3:Eu@SiO2) with an annealing process. Our results revealed that annealed Y2O3:Eu@SiO2 could directly induce comprehensive photodynamic effects under X-ray irradiation without the presence of PS molecules. The crystallinity of Y2O3:Eu@SiO2 was demonstrated to enable the generation of electron-hole (e--h+) pairs in Y2O3 under ionizing irradiation, giving rise to the formation of ROS including superoxide, hydroxyl radical and singlet oxygen. In particular, combining Y2O3:Eu@SiO2 with fractionated radiation therapy increased radio-resistant tumor cell damage. Furthermore, photoacoustic imaging of tumors showed re-distribution of oxygen saturation (SO2) and reoxygenation of the hypoxia region. The results of this study support applicability of the integration of fractionated radiation therapy with Y2O3:Eu@SiO2, achieving synchronously in-depth and oxygen-insensitive X-ray PDT. Furthermore, we demonstrate Y2O3:Eu@SiO2 exhibited radioluminescence (RL) under X-ray irradiation and observed the virtually linear correlation between X-ray-induced radioluminescence (X-RL) and the Y2O3:Eu@SiO2 concentration in vivo. With the pronounced X-RL for in-vivo imaging and dosimetry, it possesses significant potential for utilization as a precision theranostics producing highly efficient X-ray PDT for deep-seated tumors.
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[Radiotherapy for ovarian carcinoma management: Literature review]. Cancer Radiother 2020; 24:159-165. [PMID: 32151544 DOI: 10.1016/j.canrad.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 11/24/2022]
Abstract
Ovarian cancer is the fifth most common cancer in women in France with 4714 new cases in 2017. More than 70% of patients whose disease is initially locally advanced will present locoregional or distant recurrence. Therapeutic options in this situation are not consensual. They are based on chemotherapy possibly associated with an iterative cytoreductive surgery when it is bearable by the patient. The place of radiotherapy in the management of the disease is hidden in the vast majority of national or international standards. We conducted a general review of the literature to clarify the role of irradiation in the global management of ovarian cancers, particularly in recurrence.
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Kino T, Ando N, Ogawara Y, Shigeta H. Proton beam therapy for recurrent ovarian carcinoma: A case report. J Obstet Gynaecol Res 2019; 45:1952-1956. [PMID: 31332888 DOI: 10.1111/jog.14036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/25/2019] [Indexed: 11/30/2022]
Abstract
The efficacy and feasibility of proton beam therapy (PBT) for recurrent ovarian carcinoma had not been determined. Here we presented a case of recurrent ovarian carcinoma that was successfully treated with PBT. A 48-year-old woman who was diagnosed as left ovarian clear cell carcinoma underwent surgery without removal of two tumors. After achieving complete remission with postoperative chemotherapy, a recurrent tumor was found in the sigmoid colon, for which a colostomy was performed. Because second-line chemotherapy was not effective, PBT was selected; there were no complications, except for a transient low-grade fever. After 1 year of PBT, the tumor completely disappeared and the patient had been disease-free for over 8 years. PBT may be an effective and less invasive treatment modality for recurrent ovarian carcinoma.
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Affiliation(s)
- Tamina Kino
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Noriko Ando
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yuki Ogawara
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Hiroyuki Shigeta
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
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Long-Term Survival After Surgery and Radiotherapy for Recurrent or Persistent Ovarian and Tubal Cancer. Int J Gynecol Cancer 2019; 28:1090-1100. [PMID: 29846300 DOI: 10.1097/igc.0000000000001294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study examines the factors associated with long-term disease-specific survival (DSS) and complications after radiotherapy (RT) for recurrent or persistent ovarian and tubal cancer. METHODS/MATERIALS Between 1980 and 2015, 65 women with ovarian (57), tubal (3), or co-existent ovarian/endometrial carcinoma (5) received RT (>45 Gy) with curative intent for recurrent (45) or persistent cancer (20) found at second-look surgery. Surgery to debulk (± restage) was integrated into the management of all but 7 cases. RESULTS Twenty-two women had no evidence of disease at last contact after a median of 15.6 years (range = 1.0-35.8 years). Of the 53 patients treated more than 10 years ago, 18 (34%) are in this long-term no evidence of disease group. Univariate analysis showed that the following factors were significantly associated with longer DSS (P < 0.05): initial stage I, II (vs III, IV); endometrioid histology (vs serous and other); no or 1 previous chemotherapy (vs ≥2); no macroscopic tumor before RT (vs macroscopic); localized tumor encompassed by a limited-volume RT field (vs more widespread tumor), and chemotherapy and RT (vs RT only). Multivariate analysis showed that endometrioid (vs other histology HR = 4.37, P = 0.017) and localized tumor (vs more widespread tumor, HR = 2.43, P = 0.017) were significantly associated with longer DSS.After RT to the pelvis and/or abdomen, 13 (21.7%) of 60 patients developed G3 or 4 bowel complications requiring surgery. In 10, these occurred in the presence of tumor, RT changes, and adhesions, and in 3, there was no sign of cancer. Six patients (9.2%) developed a subsequent malignancy. CONCLUSIONS We conclude that there is a role for the use of RT in selected cases of localized recurrent or persistent ovarian cancer and may confer long-term survival. Surgery is useful to debulk and define the extent of tumor to be irradiated but may confer an increased risk of severe bowel complications.
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Involved-field radiation therapy for recurrent ovarian cancer: Results of a multi-institutional prospective phase II trial. Gynecol Oncol 2018; 151:39-45. [PMID: 30146110 DOI: 10.1016/j.ygyno.2018.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of involved-field radiation therapy (IFRT) in patients with locoregionally confined recurrent or persistent epithelial ovarian cancer. METHODS This study included patients with recurrent epithelial ovarian cancer eligible for IFRT either during diagnosis of the recurrence or after salvage therapies. IFRT was performed at a dose of ≥45 Gy for all tumors with 10-15-mm margins as seen on standard imaging. The primary endpoint was progression-free survival (PFS); the secondary endpoints were safety, response rate, local control, and overall survival (OS). RESULTS Thirty patients with a mean number of 5.7 metastatic lesions each were enrolled between 2014 and 2016. Seventeen were treated with 3-D conformal radiation therapy (RT) and 13 with intensity-modulated RT. IFRT was well tolerated in all patients, and acute toxicity ≥ grade 2 was not observed. One case of grade 3 abdominal pain was reported 10 months post-RT. The overall and complete response rates were 85.7% and 50%, respectively. After a median follow-up of 28 (range, 17-42) months, the median PFS was 7 months. The 2-year PFS rate was 39.3%. Six of the 16 patients who developed outfield disease progression after IFRT were successfully treated with repeat IFRT as salvage treatment. The 3-year local control and OS rates were 84.4% and 55.8%, respectively. CONCLUSIONS Although the primary endpoint was not met, IFRT might be safe and effective for in-field tumor control in patients with persistent epithelial ovarian cancer with a limited number of metastatic foci. We plan to conduct a larger scale multi-center phase II prospective study.
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Lazzari R, Ronchi S, Gandini S, Surgo A, Volpe S, Piperno G, Comi S, Pansini F, Fodor C, Orecchia R, Tomao F, Parma G, Colombo N, Jereczek-Fossa BA. Stereotactic Body Radiation Therapy for Oligometastatic Ovarian Cancer: A Step Toward a Drug Holiday. Int J Radiat Oncol Biol Phys 2018; 101:650-660. [PMID: 29893277 DOI: 10.1016/j.ijrobp.2018.03.058] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/18/2018] [Accepted: 03/28/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate stereotactic body radiation therapy (SBRT) for metachronous oligometastatic ovarian cancer patients in terms of local control, delay of systemic treatment, survival outcomes, and toxicity. METHODS AND MATERIALS Retrospective data collection from a single institution was performed. The inclusion criteria were as follows: (1) oligorecurrent or oligoprogressive disease in ovarian cancer patients during or after systemic therapy; (2) surgery or other local therapies not feasible; and (3) relative contraindication to systemic therapy for reasons such as unavailability of additional chemotherapy lines or refusal of the patient. Tumor response and toxicity were evaluated using the Response Evaluation Criteria in Solid Tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. A new systemic therapy regimen was started after an SBRT treatment course in 57 of 109 cases (52.3%). Local progression-free survival, progression-free survival, and overall survival were calculated via the Kaplan-Meier method. The systemic treatment-free interval was calculated in cases without concomitant systemic therapy. RESULTS Between May 2012 and December 2016, 82 patients (156 lesions) underwent SBRT with a median dose of 24 Gy in 3 fractions. The median follow-up period was 17.4 months. Patients received a median of 3 systemic therapy regimens prior to SBRT. Concomitant systemic therapy was performed for 29 lesions (18.6%). Among 152 evaluable lesions, a complete radiologic response, partial response, stabilization, and progressive disease were observed in 91 (60%), 26 (17%), 24 (16%), and 11 (7%), respectively. No grade 3 or 4 acute or late toxicities were observed. The median systemic treatment-free interval after SBRT was 7.4 months, and 1 of 3 patients was disease free at 1 year after SBRT. The actuarial 2-year local progression-free survival, progression-free survival, and overall survival rates were 68%, 18%, and 71%, respectively. The pattern of failure was predominantly out of field. CONCLUSIONS SBRT for oligometastatic ovarian cancer showed good local control and a good toxicity profile. It might be an appealing alternative to other invasive local therapies to delay systemic therapy in the case of chemorefractory disease or intolerance to systemic agents.
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Affiliation(s)
- Roberta Lazzari
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Sara Ronchi
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Sara Gandini
- Division of Epidemiology and Biostatistics Unit, European Institute of Oncology, Milan, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefania Volpe
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Gaia Piperno
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Floriana Pansini
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Scientific Directorate, European Institute of Oncology, Milan, Italy
| | - Federica Tomao
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University, Rome, Italy
| | - Gabriella Parma
- Department of Gynecology, European Institute of Oncology, Milan, Italy
| | - Nicoletta Colombo
- Department of Gynecology, European Institute of Oncology, Milan, Italy; University of Milano-Bicocca, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Fields EC, McGuire WP, Lin L, Temkin SM. Radiation Treatment in Women with Ovarian Cancer: Past, Present, and Future. Front Oncol 2017; 7:177. [PMID: 28871275 PMCID: PMC5566993 DOI: 10.3389/fonc.2017.00177] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/02/2017] [Indexed: 01/31/2023] Open
Abstract
Ovarian cancer is the most lethal of the gynecologic cancers, with 5-year survival rates less than 50%. Most women present with advanced stage disease as the pattern of spread is typically with dissemination of malignancy throughout the peritoneal cavity prior to development of any symptoms. Prior to the advent of platinum-based chemotherapy, radiotherapy was used as adjuvant therapy to sterilize micrometastatic disease. The evolution of radiotherapy is detailed in this review, which establishes radiotherapy as an effective therapy for women with micrometastatic disease in the peritoneal cavity after surgery, ovarian clear cell carcinoma, focal metastatic disease, and for palliation of advanced disease. However, with older techniques, the toxicity of whole abdominal radiotherapy and the advancement of systemic therapies have limited the use of radiotherapy in this disease. With newer radiotherapy techniques, including intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT), and low-dose hyperfractionation in combination with targeted agents, radiotherapy could be reconsidered as part of the standard management for this deadly disease.
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Affiliation(s)
- Emma C Fields
- Division of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, United States
| | - William P McGuire
- Internal Medicine, Virginia Commonwealth University, Richmond VA, United States
| | - Lilie Lin
- Division of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Sarah M Temkin
- Division of Gynecologic Oncology, Virginia Commonwealth University, Main Hospital, Richmond, VA, United States
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Long-term Benefit of Tumor Volume-Directed Involved Field Radiation Therapy in the Management of Recurrent Ovarian Cancer. Int J Gynecol Cancer 2017; 26:655-60. [PMID: 26825832 DOI: 10.1097/igc.0000000000000653] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aimed to report on long-term effectiveness of involved field radiation therapy (IFRT) in the salvage of localized recurrent ovarian cancer (ROC). METHODS A retrospective analysis of 27 patients with a diagnosis of epithelial ovarian cancer who received tumor volume-directed IFRT for localized extraperitoneal recurrences (either as consolidation after cytoreductive surgery (CRS) or as attempted salvage if unresectable) forms the basis of this report. All patients were heavily pretreated with multiple chemotherapy regimens. Involved field radiation therapy was primarily with external beam (median dose, 50.4 Gy). Local recurrence-free survival (LRFS) was defined as freedom from in-field recurrences and was considered as a measure of effectiveness of radiotherapy. Statistical analyses evaluated association between disease-free survival, overall survival, LRFS, and various prognostic factors. Comparison was also made with a similar but unmatched cohort with localized recurrences salvaged by additional chemotherapy instead of local therapies (NIFRT group). RESULTS Of 27 patients, 17 had optimal CRS before RT. The actuarial survival at 5 and 10 years (in parenthesis) from date of radiation were LRFS (70% and 60%), overall survival (30% and 19%), and disease-free survival (33% and 20%). None of the NIFRT patients survived beyond 5 years from initiation of salvage chemotherapy. CONCLUSIONS Long-term follow-up in this selected series confirmed the benefit of IFRT (±CRS) in localized ROC. Chemotherapy salvage in a similar NIFRT group was not equivalent, suggesting a role for locoregional therapies in selected patients with ROC.
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Hasan S, Ricco A, Jenkins K, Lanciano R, Hanlon A, Lamond J, Yang J, Feng J, Good M, Noumoff J, Brady L. Survival and Control Prognosticators of Recurrent Gynecological Malignancies of the Pelvis and Para-aortic Region Treated with Stereotactic Body Radiation Therapy. Front Oncol 2016; 6:249. [PMID: 27921006 PMCID: PMC5118455 DOI: 10.3389/fonc.2016.00249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/09/2016] [Indexed: 01/30/2023] Open
Abstract
Purpose To define prognostic factors associated with improved survival and local control (LC) for gynecologic cancer recurrences limited to the pelvis and para-aortic (PA) region using stereotactic body radiation therapy (SBRT). Methods Between 2/2008 and 7/2014, 30 women (35 targets) with pelvic or PA recurrence of endometrioid (n = 12), cervical (n = 11), ovarian (n = 3), uterine-serous (n = 2), or carcinosarcoma (n = 2) cancer were treated with SBRT. Eleven recurrences were located in the central pelvis, 11 along the pelvic sidewall (PSW), and 13 in the PA region. Results Five-year survival for all patients was 42% with a median survival of 43.4 months. Multivariate analysis revealed better performance status (PS), and smaller clinical tumor volume was significant for improved survival (p < 0.05). Conclusion SBRT is a local therapy for recurrent gynecological malignancies in the pelvis and PA region with curative potential. SBRT is especially effective for LC when targeting PSW or PA recurrence and for patients with a cervical/endometrioid uterine primary. Survival is improved for patients with better PS and smaller recurrence volume prior to SBRT.
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Affiliation(s)
- Shaakir Hasan
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Anthony Ricco
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Kaylette Jenkins
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Rachelle Lanciano
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Alexandra Hanlon
- University of Pennsylvania School of Nursing , Philadelphia, PA , USA
| | - John Lamond
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Jun Yang
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Jing Feng
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Michael Good
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Joel Noumoff
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Luther Brady
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
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Iwashita A, Takei Y, Fujiwara H, Sato N, Saito K, Suzuki M, Nakazawa M. Successful radiotherapy for repeated recurrent uterine clear cell adenocarcinoma. J Obstet Gynaecol Res 2015; 41:2002-5. [PMID: 26310385 DOI: 10.1111/jog.12816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 11/29/2022]
Abstract
Uterine clear cell adenocarcinoma (UCCA) is rare and resistant to treatment. We report a UCCA patient who responded to radiotherapy on each relapse. The first relapse was detected in the vaginal wall after the first course of postoperative adjuvant chemotherapy. Radiotherapy was conducted. Recurrent tumors were detected in the left lung after 5 months and in the right lung after 8 months. Partial resection of the lungs was performed. After 5 months, relapse was detected in the left pulmonary apex. Stereotactic radiotherapy was conducted. After 7 months, relapse was detected in the left pulmonary apex outside the irradiation field, and stereotactic radiotherapy was performed. During the subsequent 36-month follow-up, there has been no relapse. Although UCCA is resistant to treatment, radiotherapy is effective in some cases, as demonstrated in this patient. Even when relapse is repeated, radiotherapy may be considered as a treatment option if the recurrent focus is localized.
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Affiliation(s)
- Ayumi Iwashita
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Yuji Takei
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Naoto Sato
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Koyomi Saito
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Mitsuaki Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
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