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Fractionated Palliative Pelvic Radiotherapy as an Effective Modality in the Management of Recurrent/Refractory Epithelial Ovarian Cancers: An Institutional Experience

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Abstract

Background

The advent of effective chemotherapeutic agents for ovarian carcinoma has made radical abdomino-pelvic radiation redundant. Nevertheless, palliative pelvic radiotherapy still has a role in palliating local symptoms. However, its effect on progression-free survival (PFS) may be debated.

Aims

To study the outcome of fractionated palliative pelvic radiotherapy in relapsed ovarian cancers in terms of symptom control and PFS.

Methods

Twenty-three patients of ovarian cancers, heavily pretreated with chemotherapy and with recurrent or residual pelvic masses, were planned for palliative pelvic radiotherapy to the dose of 46–50 Gy in 23–25 fractions in 4.5–5 weeks. Symptom control and outcomes have been analyzed.

Results

Post-radiotherapy, abdominal pain was controlled in 15 out of 17 patients (88.2 %), bleeding per vaginum in all 5 patients and vaginal discharge stopped in 4 out of 5 patients (80 %). On follow-up, of 23 patients, 17 (74 %) had progressive disease post-radiation, and median time to disease progression was 10 months (range 1–49). On univariate analysis, increased PFS was observed in patients who received radiation late in their course of disease, those with serous histology, and with lesser disease bulk in pelvis (≤2 cm) prior to radiation initiation.

Conclusion

Fractionated palliative pelvic radiotherapy is an efficient method for symptom palliation in relapsed ovarian cancers. Patients who are heavily pretreated with chemotherapy and have a small-volume pelvic disease may show a prolonged PFS with addition of pelvic radiotherapy. Indications of radiotherapy, however, need to be defined.

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Authors and Affiliations

  1. Department of Radiotherapy, Nehru Hospital, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India

    Anshuma Bansal, Bhavana Rai, Shikhar Kumar, Vanita Suri & Sushmita Ghoshal

  2. Department of Gynecology and Obstetrics, Nehru Hospital, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India

    Vanita Suri

Authors
  1. Anshuma Bansal
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  2. Bhavana Rai
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  3. Shikhar Kumar
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  4. Vanita Suri
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  5. Sushmita Ghoshal
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Corresponding author

Correspondence to Bhavana Rai.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standard

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Since this is retrospective study, formal consent was not required.

Animals Rights

There are no ethical issues with animal subjects. This article does not contain any studies with animals performed by any of the authors.

Additional information

Dr. Anshuma Bansal is a Assistant Professor, MD of Radiation Oncology at PGIMER Chandigarh; Dr. Bhavana Rai is a Assistant Professor, MD of Radiation Oncology at PGIMER Chandigarh; Dr. Shikhar Kumar is a Junior Resident, MD of Radiation Oncology at PGIMER Chandigarh; Dr. Vanita Suri is a Professor and Head of Department, MD of Gynecology at PGIMER Chandigarh; Dr. Sushmita Ghoshal is a Professor and Head of Department, MD of Radiation Oncology at PGIMER Chandigarh.

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Bansal, A., Rai, B., Kumar, S. et al. Fractionated Palliative Pelvic Radiotherapy as an Effective Modality in the Management of Recurrent/Refractory Epithelial Ovarian Cancers: An Institutional Experience. J Obstet Gynecol India 67, 126–132 (2017). https://doi.org/10.1007/s13224-016-0926-7

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  • DOI: https://doi.org/10.1007/s13224-016-0926-7

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