Determinants of survival of patients with epithelial ovarian carcinoma following whole abdomen irradiation (WAR)

In an attempt to identify those parameters which represent predictors of clinical outcome, a retrospective review of patients with epithelial ovarian carcinoma who were primarily treated with whole abdominal irradiation (WAR) following staging laparotomy was performed. Complete records with extensive long-term follow-up were available on 102 patients treated from 1962 through 1974. Histopathologic review excluded 18 patients with lesions of low malignant potential. Of the remaining 84 cases there were 12 Stage I (14%), 23 Stage II (27%), 45 Stage III (54%), and 4 Stage IV (5%). Measure of completeness of surgical resection was expressed as the largest diameter of residual gross tumor. Following primary surgical debulking of Stages II and III patients, 24 patients had no gross residual disease, 24 patients had less than 2 cm of residual disease, and 20 patients had greater than 2 cm of residual disease. For Stages II and III patients together, 5- and 10-year actuarial survivals were: No gross residual, 69% and 59%; less than 2 cm, 48% and 42%; and greater than 2 cm, 15% and 10%. The technique of administration of WAR did not appear to influence survival. The results of this review support the concept that in selecting WAR for primary treatment of ovarian carcinoma, completeness of cytoreductive surgery should be considered. These data justify a prospective randomized study in patients with minimal residual disease following staging laparotomy comparing WAR with current first-line combination chemotherapy.