878PD - Beneficial effect of adjuvant chemotherapy and whole abdominal or pelvic radiotherapy (WAPRT) on progression free and overall survival following pr...

Date 28 September 2014
Event ESMO 2014
Session Gynaecological cancers
Topics Anti-Cancer Agents & Biologic Therapy
Ovarian Cancer
Surgery and/or Radiotherapy of Cancer
Presenter David Tan
Citation Annals of Oncology (2014) 25 (suppl_4): iv305-iv326. 10.1093/annonc/mdu338
Authors D.S. Tan1, T. Rye2, C. Barrie2, P. Shaw3, A. Fyles4, S. Laframboise3, L. Wang5, C. Gourley6, A.M. Oza7
  • 1Haematology-oncology, National University Hospital, 119228 - Singapore/SG
  • 2Gynaecologic Oncology, University of Edinburgh Cancer Research Centre, Edinburgh/GB
  • 3Gynaecologic Oncology, Princess Margaret Cancer Centre, Toronto/CA
  • 4Radiation Oncology, Princess Margaret Cancer Centre, Toronto/CA
  • 5Biostatistics, Princess Margaret Cancer Centre, Toronto/CA
  • 6Oncology, Edinburgh Cancer Research UK Centre, EH4 2XR - Edinburgh/GB
  • 7Dept. Of Medical Oncology And Hematology, Princess Margaret Cancer Centre, M5G 2M9 - Toronto/CA

Abstract

Aim

Optimum management of OCCCs following primary surgery remains unclear. While adjuvant WAPRT has been shown to improve disease free survival in OCCCs, its effect on overall survival (OS) is unknown. Scant data also exists regarding the benefit of adjuvant chemotherapy in OCCCs. The aim of this study is to evaluate the response rates (RR = PR/CR), progression free (PFS) and overall survival (OS) following adjuvant chemotherapy +/- WAPRT for OCCC.

Methods

We conducted a retrospective review of patients with OCCC treated at Princess Margaret Cancer Centre and Edinburgh Cancer Centre to evaluate RR (RECIST criteria), PFS (time from diagnosis to RECIST or clinical PD) and OS (time from diagnosis to death) following completion of chemotherapy +/- WAPRT. Adjuvant whole abdomen/ pelvic RT (WAPRT) was administered using 45Gy in 25 fractions to the pelvis +/- 23Gy in 23 fractions to the abdomen. Survival differences were analysed by log-rank analysis and multivariate cox regression analyses.

Results

A total of 256 patients with primary OCCC were identified. In 53 patients with measurable disease, an overall response rate of 30% (6CRs and 10PRs) was observed following adjuvant platinum-based chemotherapy. Forty women with FIGO stage 1 to 3 disease (stage 1 = 24, stage 2 = 10, stage 3 = 6) received adjuvant WAPRT. Median PFS and OS for all patients was 147 weeks (95% CI 94, 200) and 70mths (95% CI 32, 108) respectively. Compared with patients who did not receive WAPRT, adjuvant WAPRT was associated with significantly superior median PFS (median PFS not reached vs 133 weeks [95% CI 100,166]; p < 0.0001) and OS (median OS not reached vs 62mths [95% CI 45,79]; p < 0.0001). In multivariate analysis, independent predictors of reduced PFS included FIGO stage 2 or more at diagnosis (HR = 4.1, p = 0.0001) and residual disease >2cm (HR = 3, p = 0.0001). Independent predictors of improved PFS included adjuvant treatment with WAPRT (HR 0.37, p = 0.001), and chemotherapy (HR 0.4, p = 0.0001). Likewise for OS, adjuvant WAPRT (HR = 0.35, p = 0.014) and chemotherapy (HR 0.35, p= 0.0001), Stage 1 OCCC (HR = 0.26, p = 0.0001) and residual disease <2cm (HR = 0.2, p = 0.0001), were independently predictive of improved outcome.

Conclusions

Our data suggests that a combined adjuvant strategy of chemotherapy and WAPRT is associated with significantly improved PFS and OS in the treatment of OCCC.

Disclosure

All authors have declared no conflicts of interest.