Whole abdominal irradiation by a moving-strip technique for patients with ovarian cancer

Thus far, response rates (CP+PR) for all four arms have been comparable averaging ninety percent. While the trend of relapses favours the combined sandwich therapy, results are too early to be conclusive. One quarter of patients on sandwich therapy received less than 6 courses of chemotheraphy in addition to radiotherapy. Today no relapses have occurred in this small group of patients. Of all patients at risk at one and two years, 78% and 70% are alive. Toxicities to various organ systems have been comparable in all arms with the exception of hematopoietic toxicity which was more severe in the sandwich technique. To date, platelet toxicity has represented the greatest hazard to the combined modality approach and requires close surveillance. Herpes Zoster occurred in about two-thirds of cases in all arms but combined therapy was accompanied by more extensive and serious forms of the infection. Among factors related to toxicity in the sandwich therapy are the slower-than-expected drug clearance rate (for CCNU) and the slow recovery of hematopoiesis after radiotherapy (necessitating significant subsequent drug modifications). Details of factors related to early treatment failures (76 patients) and toxicity (drug radiation dose and timing, age, patient symptomatology, etc.) will be discussed in detail.

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EPITHELIAL CARCINOMA OF OVARY Pedro H. Morales, M.D. J. V. Fayos, M.D. Radiation Therapy Service University Hospital The University of Michigan Ann Arbor, MI 48109

A total of 176 patients with untreated epithelial cancer of ovary received post-operative irradiation at the Radiation Therapy Service of the University of Michigan from 1955 to 1973. Irradiation was delivered to the pelvis alone or to the pelvis and part of the abdomen depending on the extent of the disease and the location of the residual tumor. No patient received whole abdominal irradiation. Post-irradiation chemotherapy was used in advanced cases. Twenty-six Stage III patients were treated according to a protocol consisting of pre- and post-irradiation chlorambucil. The overall 5 year actuarial survival was 42%. The 5-year survival rates for Stages I-IV were 79%, 31%, 23%, and 0%, respectively. Patients whose tumor was grossly removed at initial surgery did better, 63% 5 year survival, than those in whom tumor was left behind, 26% 5 year survival. The pathologic grade of the tumor was a major factor in determining the prognosis. The 5 year survival rates were 76% for well differentiated carcinomas, 33% for moderately differentiated carcinomas and 14% for poorly differentiated carcinomas. The serous carcinoma group did somewhat worse than the other major groups of epithelial tumors probably due to the higher incidency of less differentiated tumors. Thirty-six (20%) of the patients were found to have at least a second primary either at the time of the intitial surgery or at some other time. Autopsy results of 25 patients in this series are presented. ASTR 21st Annual Meeting

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ADJUVANT INTRAPERITONEAL CHROMIC PHOSPHATE IN F.I.G.O. AND II OVARIAN CANCER

Fairey, R.N.', White, G.W.*, Young, M.E.J.3,

STAGE 1

Boyes, D0A.4, and Cope, J.Lo5

1.

Division of Radiation Oncology, A. Maxwell Evans Clinic Cancer Control Agency of B.C., Vancouver, B,C. V5Z 353.

2.

Deputy Head, Division of Gynaecology, Cancer Control Agency of B.C,, Vancouver, B.C. V5Z 353.

3.

Physicist, Division of Physics, A. Maxwell Evans Clinic, Cancer Control Agency of B.C., Vancouver, B.C. V5Z 353.

4.

Director, Cancer Control Agency of B.C., Head, Division of Gynaecologic Oncology, A. Maxwell Evans Clinic, Vancouver, B,C. V5Z 353,

5.

Gynaecologist,

Vancouver, B.C.

In 1974 a pilot study was initiated at the A. Maxwell Evans Clinic to examine the role of intraperitoneal chromic phosphate (32~) in F.I.G.O. Stage I and II ovarian cancer. In Stage I disease, radioactive chromic phosphate was used as an adjuvant to complete pelvic surgery only, whereas in Stage II disease it was used as an adjuvant to surgery and megavoltage pelvic irradiation. This study of over 100 patients will be reported in detail with particular emphasis on failure analysis and complication rates as well as case selection and survival data.

(“6) A,J.

WHOLE ABDOMINAL IRRADIATION BY A MOVING-STRIP TECHNIQUE FOR PATIENTS WITH OVARIAN CANCER Dembo, J. Van Dyk, B, Japp, H.A. Bean, F.A. Beale, J.F.

Pringle, R.S. Rush

Princess Margaret Hospital, Toronto, Canada M4X lK9 Between April 1971 and December 1975, 132 patients with invasive epithelial carcinoma of the ovary were subjects in a prospective study. These were patients with Stage IB, II and III presentations in whom bilateral salpingo-ophorectomy and total abdominal hysterectomy (BSOH) had been completed, The median time at risk is 5,2 years. Median age at diagnosis was 52 years, Thirty-six percent of patients had known gross residual disease (usually (2 cm). In 64% of patients it was assumed there was no gross residual disease, even when there was doubt. However, meticulous exploration of the upper abdomen was not performed in the staging of these patients. For Stages IB and II, pelvic irradiation 4500 rads midplane in 20 fractions (PEL) was taken as the standard postoperative therapy. The objective was to determine if survival could be improved by adding to this either chlorambucil 6 mg/day for 2 years (P+CH) or irradiation of the upper abdomen (P+AB). Stage III patients were randomized only between P+AB and P+CH. The essential features of the technique of P+AB used were (a) Therapy commenced with pelvic irradiation 2250 rads midplane in 10 fractions followed imediately by a downward moving-strip that encompassed-the entire abdomen and pelvis. (b) The dose to the moving-strip was 2250 rads midplane in 10 142

ASTR 21st Annual

Meeting