PARIS, France--Postoperative whole abdominal radiation (WAR) therapy
has no place in the management of ovarian cancer, David Gershenson,
MD, of the University of Texas M.D. Anderson Cancer Center, said
in a debate at the American Radium Society meeting.
However, this perspective was refuted by Gillian Thomas, MD, whose
group in Toronto has been one of the most consistent champions
of WAR therapy.
Dr. Gershenson spotlighted a panoply of problems in the older
studies comparing WAR with chemotherapy, including a lack of adequate
surgical staging in the Princess Margaret Hospital, Toronto, series,
the absence of stratification prior to randomization in the M.D.
Anderson study, and the use of ill-defined or inadequate radiotherapeutic
techniques in the Canadian NCI and Danish studies.
"Therefore," he argued, "none of these studies
resolved the most relevant question--how does WAR compare with
contemporary platinum-based combination chemotherapy?"
Likewise, he continued, of five studies that supported the superiority
of radiation over chemotherapy, four were retrospective, covering
a long period of time, and shared several common flaws.
He said that these studies were flawed because (1) they included
patients with early-stage disease, (2) had small numbers of patients
with stage III disease, (3) used chemotherapy after radiotherapy
in some patients, (4) had inadequate pathology review, (5) included
patients with borderline tumors, and (6) failed to employ aggressive
cytoreductive surgery, resulting in a possible selection bias
toward a preponderance of patients with stage IIIA or IIIB disease.
"Yet another concern is compromise of bone marrow tolerance
to chemotherapy in patients who fail to respond to postoperative
radiation," Dr. Gershenson said. He also warned of increased
complication rates in ovarian cancer patients who require laparotomy
for intestinal obstruction or other problems after receiving radiation