Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
Presenter(s)
Audrey Goodman, BS - UCI School of Medicine, Orange, CA
A. Goodman1, E. Healy2, P. Mitra2, J. V. Kuo2, S. Dwabe3, A. Hari4, R. Bristow4, J. Tseng4, K. Clair4, and G. K. Harada5; 1UCI School of Medicine, Orange, CA, 2University of California, Irvine - Department of Radiation Oncology, Orange, CA, 3University of California, Irvine, Division of Hematology/Oncology, Orange, CA, 4Department of Gynecology Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, 5Department of Radiation Oncology, University of California - Irvine, Orange, CA
Purpose/Objective(s):
Ovarian cancer is primarily managed with surgery and platinum-based chemotherapy, yet recurrence often requires multiple systemic lines. While radiation therapy (RT) is traditionally palliative, its role in limited recurrent or oligometastatic disease remains unclear. This study evaluates if salvage RT improves progression-free (PFS) and overall survival (OS) when compared to systemic therapy alone.Materials/Methods:
We performed a single institution retrospective review of patients referred to our department for consideration of salvage RT between 2016 and 2025. All patients had a diagnosis of primary ovarian cancer and had evidence of unresectable locoregionally recurrent or low volume oligometastatic disease (= 3 sites). Patients were excluded for poor performance status (ECOG = 3) and either received salvage RT or systemic therapy. Baseline characteristics were compared using Fisher’s exact and either Wilcoxon rank sum or two-sided t-tests for categorical and continuous variables, respectively. PFS and OS were measured from the date of salvage therapy initiation and censored to the date of final follow up or death, using the Kaplan-Meier method and log-rank test to assess differences in PFS and OS (p < 0.05).Results:
A total of 40 patients were deemed eligible for study with a median age of 56.5 years (range 24.0 - 73.0). Most had high-grade serous ovarian carcinoma (30/40 = 75.0%) followed by other high-grade carcinomas of unspecified subtypes (7/40 = 17.5%). Three patients had low to intermediate grade ovarian cancers. Patients recommended for salvage RT (30/40 = 75.0%) had a similar advanced FIGO stage at original presentation (p = 0.316), most commonly stage IIIC (16/30 = 53.3%). Patients recommended for salvage RT received more lines of systemic therapy prior to initial consultation than receiving systemic salvage alone (median 5 vs 2 systemic lines; p = 0.030). Recurrent or oligometastatic disease frequently involved the pelvis (9/30 = 30.0%), para-aortics (5/30 = 16.7%), or brain (4/30 = 13.3%). Patients receiving RT were treated with a median BED10 of 59.5 Gy (IQR = 50.4 – 72.0 Gy) with most using stereotactic body radiation therapy (24/30 = 80%) or stereotactic radiosurgery (3/30 = 10%) to one area of active disease. Patients receiving salvage RT had a significantly higher median PFS (18 months vs 1 month) and OS (NR vs 15 months) compared to those receiving systemic salvage (p = 0.001).Conclusion:
RT remains an underexplored frontier in the management of ovarian cancer. We demonstrate that salvage RT may be an excellent option for patients with unresectable locoregionally recurrent or oligometastatic disease and may significantly improve PFS and OS when compared to continuation of systemic therapy alone. However, these outcomes reflect a carefully selected population with limited volume disease and preserved performance status. Further prospective study is warranted to better understand what role RT has in managing recurrent and oligometastatic ovarian cancer.