Palliative Radiotherapy in Ovarian Cancer

Unfortunately, recurrent or persistent ovarian cancer following adjuvant chemotherapy is relatively common and incurable. Usually, second-, third- or fourth-line chemotherapy is used in attempts to prolong life and palliate symptoms. Little specific data are available to judge the degree of symptom relief provided. Response rates range between 10% and 43% and are associated with various toxicities. Radiotherapy as a palliative modality in ovarian cancer is often neglected but may be very useful if the sole dominant symptomatic problem for the patient is localized to a site and volume that may be safely encompassed in a limited radiation field. For example, a fixed pelvic mass eroding the vaginal mucosa causing bleeding, pain or bowel or bladder dysfunction may occur without obvious disseminated symptomatic peritoneal disease. Localized masses in the retroperitoneal nodes or in extra abdominal sites such as the supraclavicular or inguinal node regions or bony or brain metastases may benefit from palliative irradiation as would painful hepatomegaly from hepatic capsular distention.

Recently a number of reports have documented the high objective and subjective response rate of patients treated with radiation for recurrent ovarian cancer after resistance to available chemotherapeutic agents has developed. Large single fraction irradiation, usually one to three fractions of 10 Gy has been investigated. A 55% response rate for palliation of pain and 71% of bleeding was reported although severe bowel complications occurred in six of 42 patients, probably related to the high dose per fraction employed. Another report of palliative radiotherapy used after initial management with cisplatin-containing regimens documented that radiotherapy produced a mean symptom-free interval of 8.5 months and the median survival was 19.5 months using fractionated palliative irradiation. They reported a complete palliative response in 51% of 33 patients and overall palliative responses in 79%. The median duration of palliation was four months which reflected palliation until death in 90% of cases. Vaginal or rectal bleeding was controlled in 90% and 85% respectively and pain relief occurred in 83%. A study from Memorial Sloan-Kettering Cancer Center documented subjective or objective responses in 70% of patients who had platinum-refractory disease who had not previously received paclitaxel. While the optimal dose for palliation has not been established, it is clear that durable palliation may be achieved with local radiotherapy for ovarian cancer recurring after chemotherapy even in the presence of chemoresistant disease.

Palliative whole brain irradiation is indicated for documented cerebral metastases in those whose life expectancy is several weeks to months. Corn and collegues reported symptomatic response in 23 of 32 patients which was maintained until death in 71% At the present time, CNS relapse remains sufficiently uncommon that prophylactic cranial irradiation is not recommended.