Radiation Treatment in Women with Ovarian Cancer: Past, Present, and Future

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.

Keywords: abscopal effect; novel therapeutics; ovarian cancer; poly(ADP-ribose) polymerase inhibitors; radiation.

Figure 1

Techniques for treating whole abdominal radiation. (A) Open field technique AP beam. (B) Open field technique PA beam with kidney blocks.

Figure 2

Stereotactic body radiotherapy (SBRT) plan for the treatment of a para-aortic lymph node for a woman with recurrent serous ovarian cancer. The plan is shown in axial, sagittal, and coronal orientations. The planning target volume is color washed in green, the kidneys are yellow, and blue and the bowel is orange. The dose is 30 Gy and prescribed in five fractions.

Figure 3

Dosimetric comparisons of three dimensional conformal and intensity modulation radiation therapy (IMRT) plans for whole abdominal radiotherapy. The plans are each shown in axial, sagittal, and coronal orientations and the dose volume histogram comparison is below. The planning target volume (whole abdominal cavity) is red, liver is yellow, kidneys are green, and bone marrow is brown. The IMRT plan is the dashed lines and the 3DCRT plan DVH’s are solid.