Intensity-Modulated Whole Abdominal Radiotherapy After Surgery and Carboplatin/Taxane Chemotherapy for Advanced Ovarian Cancer: Phase I Study

• Published in: International journal of radiation oncology, biology, physics Vol. 76; no. 5; pp. 1382 - 1389
• Main Authors: Rochet, Nathalie, M.D, Sterzing, Florian, M.D, Jensen, Alexandra D., M.D, Dinkel, Julien, M.D, Herfarth, Klaus K., M.D, Schubert, Kai, Ph.D, Eichbaum, Michael H., M.D, Schneeweiss, Andreas, M.D, Sohn, Christof, M.D, Debus, Juergen, M.D., Ph.D, Harms, Wolfgang, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2010
• Subjects: ABDOMEN; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; BODY; Carboplatin - administration & dosage; CARCINOMAS; CHEMOTHERAPY; Combined Modality Therapy - adverse effects; Combined Modality Therapy - methods; COMPUTERIZED TOMOGRAPHY; Consolidation treatment; CT-GUIDED RADIOTHERAPY; DIAGNOSTIC TECHNIQUES; Diarrhea - etiology; DISEASES; Dose Fractionation; Feasibility Studies; Female; FEMALE GENITALS; GONADS; Heart - radiation effects; Helical tomotherapy; Hematology, Oncology and Palliative Medicine; Humans; Kidney - radiation effects; Leukopenia - etiology; Liver - radiation effects; MEDICINE; Middle Aged; NEOPLASMS; NUCLEAR MEDICINE; ORGANS; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - pathology; Ovarian Neoplasms - radiotherapy; Ovarian Neoplasms - surgery; OVARIES; Pelvic Bones - radiation effects; Prospective Studies; Radiation Injuries - prevention & control; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Spine - radiation effects; Step-and-shoot intensity-modulated radiotherapy; SURGERY; THERAPY; Thrombocytopenia - etiology; TOMOGRAPHY; TOXICITY; Whole abdominal radiotherapy; Step-and-shoot intensity-modulated radiotherapy; Helical tomotherapy; Consolidation treatment; Whole abdominal radiotherapy; Ovarian cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.03.061

Purpose To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. Methods and Materials Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique ( n = 3) or a helical tomotherapy technique ( n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones. Results Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea ( n = 1), thrombocytopenia ( n = 1), and leukopenia ( n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients. Conclusions The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.