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 therapy.