Stereotactic Body Radiotherapy For Oligometastatic Ovarian Cancer: A Step Towards A Drug Holiday

Publication date: Available online 4 April 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Roberta Lazzari, Sara Ronchi, Sara Gandini, Alessia Surgo, Stefania Volpe, Gaia Piperno, Stefania Comi, Floriana Pansini, Cristiana Fodor, Roberto Orecchia, Federica Tomao, Gabriella Parma, Nicoletta Colombo, Barbara Alicja Jereczek-Fossa
PurposeTo evaluate stereotactic body radiotherapy (SBRT) for metachronous oligometastatic ovarian cancer patients in terms of local control, delay of systemic treatment, survival outcomes and toxicity.Materials and MethodsRetrospective data collection from a single institution. Inclusion criteria were: (1) oligorecurrent/oligoprogressive disease in ovarian cancer patients after/during systemic therapy; (2) surgery/other local therapies not feasible; (3) relative contraindication to systemic therapy, no more chemotherapy lines available 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 (CTCAE) v4.03, A new systemic therapy regimen was started after SBRT treatment course in 57/109 cases (52.3%).respectively. Local progression free survival (LPFS), progression free survival (PFS) and overall survival (OS) were calculated via Kaplan-Meier method. Systemic treatment free interval (SFI) was calculated in cases without concomitant systemic therapy.ResultsBetween May 2012 and December 2016, 82 patients/156 lesions underwent SBRT with a median dose of 24 Gy/3 fractions. Median follow-up 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%). Complete radiologic response, partial response, stabilization and progressive disease were observed in 91 (60%), 26 (17%), 24 (16%) and 11 (7%) lesions, respectively, out of 152 evaluable lesions. No G3-G4 acute or late toxicities were observed. Median SFI after SBRT was 7.4 months and 1 out 3 patients was disease free at 1 year after SBRT. Actuarial 2-year LPFS, PFS and OS rates were 68%, 18% and 71%, respectively. Pattern of failure was predominantly out-field.ConclusionsSBRT for oligometastatic ovarian cancer showed good local control and toxicity profile. It might be an appealing alternative to other invasive local therapies in order to delay systemic therapy in case of chemorefractory disease or intolerance to systemic agents.

Teaser

This study including 82 patients showed that stereotactic radiotherapy for oligometastatic ovarian cancer is feasible, well tolerated and offers high local control. At 1 year, 1 out of 3 patients is free of progression and new treatments.


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