Stereotactic Body Radiotherapy for Lymph Node Relapse in Ovarian Cancer

Trippa F, Casale M, Draghini L, Anselmo P, Arcidiacono F and Maranzano E

Radiation Oncology Centre, S.Maria Hospital, Terni, Italy

^*Correspondance to: Fabio Trippa 

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Abstract:

Purpose: To evaluate the effectiveness and toxicity of stereotactic body radiotherapy (SBRT) for lymph node relapse in patients with ovarian cancer. Material and
Methods: Between August 2008 and March 2015, 11 patients were treated with SBRT on 20 lymph nodes of previous ovarian cancer. All patients at the time of ovarian cancer diagnosis were submitted to surgery and at least one line of chemotherapy (range, 1-3). Median age was 64 years (range, 49-74), and primitive histology was siero-papillar and endometrioid carcinoma in 8 (72%) and 3 (28%) patients, respectively. Median time between first diagnosis and lymph node relapse was 79 months (range, 16-171). Lymph node recurrence was documented with PET-CT as the only site of disease. Response was evaluated with PERCIST (PET Response Criteria in Solid Tumors) criteria.
Results: Median follow-up was 24 months, median Gross Tumor Volume (GTV) 5.35 cc (range, 1.5-18.3), median Planning Target Volume – obtained adding an isotropic margin of 5 mm to the GTV– 15.6 cc (range, 4.2-85.7). The lymph node relapsing sites were 14 (70%) sub-diaphragmatic (i.e., pelvic and lumbo-aortic), and 6 (30%) mediastinal. Fractionation schemes were 5 x 8Gy in 10 (50%), 5 x 7Gy in 2 (10%), 5 x 6Gy in 3 (15%) and 5 x 5Gy in 5 (25%) lymph nodes. Outcome, evaluated with PET-CT 3 months after SBRT, showed a complete metabolic response in all treated lesions. Local control (LC) at 2- and 5 years was 73% +/- 12 and 48% +/- 20, respectively and median duration of LC was 57 months. Outcome resulted related to administered doses. In fact, at the univariate analysis, LC was significantly better in 5 x 8Gy group versus 5 x < 8Gy group (p = 0.004). Cancer specific survival and overall survival at 2- and 5 years were 87% +/- 11 and 73% +/- 16 and 78% +/- 14% and 65% +/- 16, respectively. We did not register acute or late toxicity after SBRT. Conclusions: All ovarian cancer patients submitted to SBRT for lymph node relapse had a durable complete metabolic response without toxicity. Outcome was related to higher doses. The good rates of cancer specific and overall survivals were probably associated to an accurate patient selection that identified true oligometastatic lesions suitable for an ablative local therapeutic approach as SBRT.

Keywords:

Stereotactic body radiotherapy; Ovarian cancer; Oligometastases

Cite the Article:

Trippa F, Casale M, Draghini L, Anselmo P, Arcidiacono F, Maranzano E. Stereotactic Body Radiotherapy for Lymph Node Relapse in Ovarian Cancer. Clin Oncol. 2016; 1: 1038.