Radiation Therapy of Ovarian Carcinoma

Abstract

There has been considerable energy devoted to the study of epithelial cancer of the ovary during the last decade. Although the impact of this effort on the overall mortality from the disease has been depressingly small, advances have been made. The principles of surgical, radiotherapeutic and chemotherapeutic management are better understood, even if there is uncertainty about the precise place of each in the overall therapeutic armamentarium. There is also improved understanding of the patterns of spread of the disease and of the prognostic importance of several tumor-related variables. Recognizing the significance of these factors has brought out the complexity of evaluating the results of treatment. This is because results are often reported in a univariate mode, e.g., by stage, or residium, or grade, but not by considering several variables at once in a multivariate manner. A pioneering example of multifactorial analysis in ovarian cancer was presented by Griffiths, but for the most part the multifactorial presentation of treatment outcome has been avoided [la]. In many ways, however, those techniques of analysis which allow us to take account of several prognostic factors at once provide the clearest understanding of this disease. A valuable perspective on the place of radiotherapy in ovarian cancer can be gained by considering it in the light of these issues. Accordingly this essay will be in three sections, dealing with problems in interpreting results of treatment, the use of prognostic factors in classifying patients for prediction of treatment outcome and choice of therapy, and finally a critical review of a few selected trials of external beam radiation therapy.