Abstract
The aim of the study was to evaluate long-term toxicity of adjuvant treatment in early
stage ovarian cancer survivors. Data from all patients treated in one hospital for
early stage ovarian cancer diagnosed between 1980 and 1990 were collected using a
structured data form. In 93 FIGO stages I and II patients, cytoreductive and staging
surgery was performed; 15 received no adjuvant treatment (controls), 39 whole abdominal
radiotherapy (WART) and 39 platin-based chemotherapy. Median age at diagnosis was
54 years (range 21–83 years). During follow-up, 49/93 (53%) patients have died with a median overall survival
of 18.4 years (95% CI 12.8–23.9). In both the radiotherapy and the chemotherapy group, 50%
of patients reported long-term side-effects (all grades) versus 13% of controls. Two
patients in the WART group died from bowel complications. Secondary malignancies were
observed in 16 patients. Of all patients alive at the last follow-up, 12/17 (71%)
patients treated with radiotherapy and 11/18 (61%) treated with chemotherapy experienced
long-term morbidity versus 2/9 (22%) controls (P = 0.03).
In conclusion: Long-term follow-up of early stage ovarian cancer patients showed lasting
GI morbidity in the survivors treated with adjuvant radiotherapy, which has therefore
become obsolete. Cisplatin-based chemotherapy caused peripheral neuropathy versus
virtual absence of problems in the survivors of just surgery, emphasising the need
for strict criteria before instigating adjuvant treatment.
Keywords
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References
- Cancer of the ovary.New Engl J Med. 2004; 351: 2519-2529
- The Princess Margaret Hospital study of ovarian cancer: stages I, II, and asymptomatic III presentations.Cancer Treat Rep. 1979; 63: 249-254
- Epithelial ovarian cancer: the role of radiotherapy.Int J Radiat Oncol Biol Phys. 1992; 22: 835-845
- Integrating radiation therapy in the curative management of ovarian cancer: current issues and future directions.Semin Radiat Oncol. 2000; 10: 61-70
- Systematic review of adjuvant therapy for early stage (epithelial) ovarian cancer.Int J Gynecol Cancer. 2003; 13: 395-404
- First-line therapy for ovarian carcinoma: what’s next?.Cancer Invest. 2004; 22: 21-28
- Standard treatment in advanced ovarian cancer in 2005: the state of the art.Int J Gynecol Cancer. 2005; 15: 212-220
- International Collaborative Ovarian Neoplasm trial 1 and Adjuvant ChemoTherapy in Ovarian Neoplasm trial: two parallel randomized phase III trials of adjuvant chemotherapy in patients with early-stage ovarian carcinoma.J Natl Cancer Inst. 2003; 95: 105-112
- Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm trial.J Natl Cancer Inst. 2003; 95: 113-125
- International Collaborative Ovarian Neoplasm trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer.J Natl Cancer Inst. 2003; 95: 125-132
- Adjuvant whole abdominal radiotherapy in epithelial cancer of the ovary.Int J Radiat Oncol Biol Phys. 2002; 53: 360-365
- Leukemia following chemotherapy for ovarian cancer.New Engl J Med. 1990; 322: 1-6
- Second malignant neoplasms among long-term survivors of ovarian cancer.Cancer Res. 1996; 56: 1564-1570
- Cardiovascular morbidity in long-term survivors of metastatic testicular cancer.J Clin Oncol. 2000; 18: 1725-1732
- Long-term survivors of ovarian malignancies after cisplatin-based chemotherapy; cardiovascular risk factors and signs of vascular damage.Eur J Cancer. 2004; 40: 696-700
- Total abdominal irradiation in stage I and II carcinoma of the ovary.Radiother Oncol. 1988; 11: 305-310
DCTD NND. Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0. 12.12.2003.
- Adverse event reporting and developments in radiation biology after normal tissue injury: International Atomic Energy Agency consultation.Int J Radiat Oncol Biol Phys. 2006; 64: 1442-1451
- Estimation of failure probabilities in the presence of competing risks: new representations of old estimators.Stat Med. 1999; 18: 695-706
- Is adjuvant radiotherapy in early stages (FIGO I–II) of epithelial ovarian cancer a treatment of the past?.Oncol Rep. 2005; 14: 521-529
- Long-term follow-up after adjuvant chemotherapy in completely resected early stage ovarian carcinoma.Eur J Obstet Gynecol Reprod Biol. 1997; 72: 181-190
- Twenty-five year outcome of sequential abdominal radiotherapy and melphalan:implications for future management of epithelial carcinoma of the ovary.Gynecol Oncol. 2005; 96: 307-313
- Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004.Hypertension. 2007; 49: 69-75
- Why actuarial estimates should be used in reporting late normal-tissue effects of cancer treatment … now!.Int J Radiat Oncol Biol Phys. 1995; 32: 1531-1534
- Acute and long-term toxicity following radiotherapy alone or in combination with chemotherapy for locally advanced cervical cancer.Cancer Treat Rev. 2003; 29: 471-488
The International Collaborative Ovarian Neoplasm (ICON) Group. Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet 2002;360:505–15.
- High-dose whole abdominal and pelvic irradiation for treatment of ovarian carcinoma: long-term toxicity and outcomes.Int J Radiat Oncol Biol Phys. 2003; 57: 201-207
Article info
Publication history
Published online: February 09, 2009
Accepted:
January 6,
2009
Received in revised form:
December 18,
2008
Received:
March 20,
2008
Identification
Copyright
© 2009 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
