Role of radiotherapy in the treatment of cancer of the ovary.

The initial management of carcinoma of the ovary is surgical. The need for further treatment is determined by a consideration of tumor stage, grade, and the presence of residual disease. Approximately one-third of patients are suitably managed by primary post-operative radiotherapy directed to the entire abdomen and pelvis with curative intent. Patients are mainly derived from stages I and II. Stage III patients are also included if the tumor is of low grade and there is no pelvic residuum. The dose which can be safely delivered to the upper abdomen is limited by normal tissue tolerance. Curative radiation is inappropriate for patients with upper abdominal disease and/or more than small volume residuum in the pelvis. These patients are best managed with chemotherapy. Suitably selected patients have a ten-year relapse-free survival of 68% following radiotherapy. Acute gastrointestinal symptoms are common during the treatment, but are usually amenable to symptomatic management. Long term morbidity is infrequent, and with modern techniques the incidence of treatment-related small bowel obstruction is around 5%. Radiotherapy to the abdomen and pelvis has also a potential role as consolidative treatment in patients with advanced disease, following a favourable response to chemotherapy.