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Clinical Oncology, St
Bartholomew's Hospital,
London, UK
Correspondence to
Dr Melanie E Powell, Clinical
Oncology, St Bartholomew's
Hospital, London EC1A 7BE, UK; ​ Presently, a role is emerging for modern radiotherapy
melanie.​powell10@​nhs.​net
Received 16 October 2021
Accepted 7 January 2022
© IGCS and ESGO 2022. No
commercial re-­use. See rights
and permissions. Published by
BMJ.
To cite: Durno K, Powell ME.
Int J Gynecol Cancer
2022;32:366–371.
366
The role of radiotherapy in ovarian cancer
Kimberley Durno, Melanie E Powell ‍ ‍
ABSTRACT
Epithelial ovarian cancer accounts for around 1.9% of
all malignancies and often presents late at an advanced
stage. Prognosis is therefore poor. Currently the mainstay
of treatment is radical cytoreductive surgery and
chemotherapy but, in the past, the standard of care also
included adjuvant whole abdominal radiotherapy. This is no
longer standard practice, largely due to high toxicity rates
and the effectiveness of platinum-­based chemotherapy.
techniques in both the salvage and palliative settings. This
review aims to examine the historical use of radiotherapy
in ovarian cancer before looking forward to its potential
future role.
INTRODUCTION
Ovarian cancer is the eighth most common cancer
in women worldwide and in 2018 there were around
300 000 cases reported, accounting for 4.4% of
entire cancer mortality in women.1 2 Around 60% are
diagnosed at an advanced stage with disseminated
peritoneal malignancy. With a 5-­year survival rate of
less than 50%, it is one of the most lethal cancers.3
There are five main histological types of epithelial
ovarian cancer: high grade serous, low grade serous,
endometrioid, clear cell, and mucinous. Each has
varying patterns of presentation and outcome. High
grade serous is the predominant cell type and tends
to present with advanced disease. Although most
cases are sporadic, around 20% are associated with a
genetic predisposition, often affecting genes involved
in homologous recombination DNA repair, of which
BRCA1 and BRCA2 are the best known. Low grade
serous accounts for around 10% of ovarian cancers
and, although often less aggressive with a more indo-
lent prognosis, they are less chemosensitive than high
grade serous cancers. Clear cell ovarian carcinoma
is often seen in a younger age group and may be
associated with endometriosis. Mucinous tumors are
rare and, if detected at an early stage, have a good
prognosis.
Surgery together with platinum-­ based chemo-
therapy is the mainstay of treatment for ovarian
cancer, with targeted treatments such as bevaci-
zumab and poly-­ADP ribose polymerase (PARP) inhib-
itors introduced to improve outcome. Radiotherapy
has largely fallen out of favor in the treatment of
ovarian cancer, although there is renewed interest
for early clear cell cancer and in the use of targeted
stereotactic treatment.
Durno K, Powell ME. Int J Gynecol Cancer 2022;32:366–371. doi:10.1136/ijgc-2021-002462
In this review we present a summary of the histor-
ical perspective for the use of radiotherapy in the
management of ovarian cancer and discuss where it
could be routinely re-­integrated into the present day
treatment pathway.
HISTORICAL PERSPECTIVE: ADJUVANT POST-
OPERATIVE WHOLE ABDOMINAL RADIOTHERAPY
Whole abdominal radiotherapy for ovarian cancer
was standard of care in the 1960s and 1970s using
basic radiotherapy techniques, delivered with the aim
of sterilizing the region and reducing recurrences
within the peritoneal cavity.4 Whole abdominal radi-
otherapy must limit the radiation dose within the
upper abdomen to ensure the dose to the small bowel
does not exceed radiation tolerance. The small bowel
is very radiosensitive and exceeding proven safe
Protected by copyright.
doses may lead to a high rate of fistula formation,
stricture, and chronic enteritis. However, limiting the
overall dose to remain within bowel tolerance results
in a sub-­optimal dose to any macroscopic residual
disease, which requires a higher radiation dose to be
tumoricidal. Adjuvant whole abdominal radiotherapy
treatment was therefore only part of curative therapy
in the sub-­set of patients with microscopic disease.
A defining trial at Princess Margaret Hospital in the
1970s evaluated patient selection for whole abdom-
inal radiotherapy and identified a sub-­set who were
most likely to benefit from adjuvant radiotherapy.5
As those with stage I, grade 1 disease have 5-­year
relapse-­free survival rates of >95% with surgery
alone, no randomized data exist demonstrating an
overall survival benefit from post-­operative radiation
in this sub-­set of patients.4 Multifactorial analysis
determined that advanced age, tumor grade, densely
adherent tumors, and positive cytology were poor
prognostic factors placing patients at higher risk of
recurrence.6 Following prognostic sub-­ grouping,
whole abdominal radiotherapy was recommended for
any patient deemed to have intermediate risk disease
defined as stage I, grade 2 and 3 or stage II, grade
1, 2 or 3 with no residual disease, or grade 1 or 2
with <2 cm residuum or stage III, grade 1 with <2 cm
residuum.7 Using whole abdominal radiotherapy in
this sub-­set of patients resulted in a 67% disease-­
free survival rate at 10 years.5
The benefit of adjuvant radiotherapy was also
reported to vary with histological sub-­group, and Patel
et al concluded that patients with stage III mucinous
 Review

Int J Gynecol Cancer: first published as 10.1136/ijgc-2021-002462 on 7 March 2022. Downloaded from http://ijgc.bmj.com/ on March 16, 2022 at Hospital Fundación Jiménez Díaz G3.
ovarian cancer had the most significant overall survival benefit
with whole abdominal radiotherapy, from 26% to 45% at 10 years
(p=0.052).8

HISTORICAL PERSPECTIVE: ADJUVANT WHOLE ABDOMINAL

RADIATION VERSUS ADJUVANT CHEMOTHERAPY
There are a limited number of trials comparing adjuvant whole
abdominal radiotherapy with platinum-­based chemotherapy, which
was first introduced as a treatment for ovarian cancer in 1978 and
its success resulted in the cessation of adjuvant radiotherapy as
standard of care. A randomized controlled trial performed between
1985 and 1989 comparing whole abdominal radiotherapy with
combination cisplatin and cyclophosphamide chemotherapy in the
adjuvant setting was discontinued after accrual of only 70 patients
due to difficulty with recruitment and protocol compliance. Early
data showed increased toxicity with whole abdominal radiotherapy
and a non-­significant improvement in both relapse-­free survival
and overall survival with chemotherapy compared with whole
abdominal radiotherapy.9 Figure 1 Whole abdominal radiotherapy field using a three-­
Prior to platinum chemotherapy, adjuvant whole abdominal dimensional conformal radiotherapy technique. Included in
radiotherapy was compared with older chemotherapy agents. A trial the radiation field are abdominal and pelvic organs including
by Smith et al in 1975 of 149 patients with stage I and II disease the bladder, kidneys, liver, and bowel. Shielding is applied to
treated with adjuvant melphalan or adjuvant radiotherapy demon- the femoral heads and above the diaphragm.
strated benefit from radiotherapy over chemotherapy, particularly in

stage I patients.10 This benefit was not uniformly reproduced, and
further trials suggested no overall difference between adjuvant pre-­
platinum chemotherapy and radiotherapy. These early trials were
published prior to aggressive cytoreductive surgery with accurate
clinical staging, thereby disease extent was likely to have been
underestimated.11 Also, owing to considerable heterogeneity within
the studies, and without sufficient level I evidence, it is not possible
to draw accurate conclusions on the effectiveness of whole abdom-
inal radiotherapy compared with chemotherapy (either pre- or post-­
platinum agents) in the adjuvant setting.4 12
CONSOLIDATIVE WHOLE ABDOMINAL RADIOTHERAPY
FOLLOWING SURGERY AND CHEMOTHERAPY
Following the routine use of platinum-­based chemotherapy in the
adjuvant setting, consolidative whole abdominal radiotherapy was
reviewed as an addition to surgery and chemotherapy.
Two European randomized trials in 1999 and 2003 reported
favorable outcomes with consolidative whole abdominal radio-
therapy; an Austrian study with 64 patients and a Swedish prospec-
tive randomized controlled trial of 172 patients. The Austrian study
randomized patients with stages IC–IV ovarian cancer with no
residual disease following surgery to either adjuvant platinum-­
based chemotherapy alone or with the addition of whole abdominal
and pelvic radiation. The results showed an impressive improved
5-­year relapse-­free survival rate of 49% with radiation versus 26%
without, and an overall survival of 59% versus 33% (p=0.012).13
The Swedish study included only patients with stage III disease.
After primary surgery and platinum-­based chemotherapy, patients
underwent a second look laparotomy and those with either no
disease or microscopic residual disease were randomized to active
surveillance, further platinum-­ based chemotherapy, or whole
Protected by copyright.
abdominal radiotherapy. In patients with a complete response,
progression-­ free survival was significantly better (p=0.032) in
those receiving radiotherapy than in the chemotherapy and control
groups. In the radiotherapy group, median progression-­free survival
was 116 months compared with 37 months and 32 months in the
chemotherapy and observation groups, respectively. The addition
of radiotherapy also showed a trend towards an overall survival
benefit and a 43% reduction in pelvic recurrences.14
The delivery of radiation at this time used large anterior and
posterior fields (Figure 1) which led to high toxicity rates and whole
abdominal radiotherapy was often discontinued early due to grade
3 or 4 gastrointestinal or hematological toxicity. Patients also
suffered severe late effects including small bowel obstruction or
sacral insufficiency fractures.15
The current standard of care for radical radiotherapy is inten-
sity modulated radiotherapy (IMRT) or volumetric modulated arc
therapy (VMAT), which allows the radiation dose to be shaped
around a target and avoid critical organs. This minimizes toxicity
and facilitates dose escalation.
The OVAR-­IMRT-­01 single-­center phase I/II pilot trial was under-
taken to evaluate planning feasibility and toxicity of adjuvant IMRT
to the whole abdomen (30 Gy/20#) in a small number of ovarian
cancer patients with International Federation of Gynecology and
Obstetrics (FIGO) stage III disease (R1 or R2 <1 cm) after resec-
tion and platinum-­based chemotherapy.16 Although an IMRT plan
may still risk basal pneumonitis, it reduces bone marrow dose and
renal toxicity. The trial was subsequently expanded into the OVAR-­
IMRT-­02 trial which evaluated 20 patients. All completed treatment
as scheduled and late side effects included one grade 3 lower limb
edema and three grade 3 elevation of liver enzymes, but no grade
3 bowel toxicity.17 This is in stark contrast to the high grade 3 and
4 bowel toxicity rates previously reported with whole abdominal

Durno K, Powell ME. Int J Gynecol Cancer 2022;32:366–371. doi:10.1136/ijgc-2021-002462 367

Review
radiotherapy. The 3-­year progression-­free survival rate was 40%
and the 3-­year overall survival rate was 83%.18
Despite the potential benefits seen, the OVAR-­IMRT-­02 trial eval-
uated only a small number of patients and has not led to a phase
III trial. Thus, controlled evidence for IMRT/VMAT as adjuvant treat-
ment in epithelial ovarian cancer is lacking.
ADJUVANT RADIOTHERAPY FOR OVARIAN CLEAR CELL
CARCINOMA
Ovarian clear cell carcinoma exists as a distinct histological sub-­
group which is more resistant to chemotherapy. Although often
detected at an earlier stage (around 80% are stage I/II at presenta-
tion), patients with high-­risk features including capsular rupture,
disease on the surface of the ovary or positive cytology and those
with advanced stage disease have significantly worse outcomes
than their matched serous controls and, on relapse, mortality rates
are high with short post-­recurrence survival rates.19–21 Adjuvant
treatment in this sub-­group of patients is not currently standard-
ized, but interest has grown in evaluating the use of radiotherapy.
In an initial promising study in 2007 where 16 patients with
stage IC–III ovarian clear cell carcinoma with <2 cm macroscopic
residual disease following surgery were treated with radiotherapy
to the whole abdomen and pelvis and their outcomes compared
with historical controls, 5-­year overall survival rates were 81.8% in
the radiotherapy group compared with 33.3% in the control group
(p=0.031). Two patients developed radiation enterocolitis requiring
bowel surgery.22
In 2012, Hoskins et al published a retrospective review of 241
patients with ovarian clear cell carcinoma treated with surgery
followed by platinum doublet chemotherapy and radiotherapy. For
those patients with stage IA and IB disease no benefit was noted
from the radiotherapy; however, a 5-­year disease-­free survival
benefit of 20% was seen in the sub-­set of patients with stage IC
and II disease treated with chemotherapy plus whole abdominal
radiotherapy.23
Not all studies have shown a benefit from radiotherapy in clear
cell ovarian cancer. In 2016, Hogen et al reviewed a cohort of
patients with stage I and II ovarian clear cell carcinoma treated with
adjuvant radiotherapy. Although there was a small improvement in
progression-­free survival at 10 years, this was not significant and
nor was the overall survival difference.24
A large retrospective review in 2020 evaluating adjuvant treat-
ment in ovarian clear cell carcinoma found 153 eligible patients
with stage IC and II clear cell carcinoma. It compared long-­term
outcomes in those treated with adjuvant chemotherapy alone
versus chemotherapy and radiotherapy. The study also further
separated those receiving radiotherapy into whole abdominal
radiotherapy (22.5 Gy in 22 fractions to the whole abdomen then
22.5 Gy in 10 fractions to the pelvis) or pelvic nodal radiotherapy
(45 Gy in 25 fractions). There was a significant improvement in
5-­year failure-­free survival rates with radiotherapy: 60.6% with
whole abdominal radiotherapy and 53.8% with pelvic nodal radio-
therapy compared with 45.9% for chemotherapy alone (p=0.03).
Despite better failure-­free survival, the addition of radiotherapy did
not improve overall survival. The difference between the two radio-
therapy techniques was non-­significant for peritoneal recurrence
368 Durno K, Powell ME. Int J Gynecol Cancer 2022;32:366–371. doi:10.1136/ijgc-2021-002462
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and local failure rates although, as might be expected, there were
a higher number of para-­aortic node relapses in the pelvic nodal
radiotherapy group. There were three treatment-­related deaths
in the whole abdominal radiotherapy group including small bowel
obstruction, radiotherapy-­induced liver disease, and a thromboem-
bolic event.25
Despite the studies demonstrating that there is unlikely to be
a significant overall survival benefit from adjuvant whole abdom-
inal radiotherapy in localized ovarian clear cell carcinoma, there
is a suggestion that pelvic radiotherapy, which is less toxic than
whole abdominal radiotherapy, may be considered to improve local
disease control.
RADIOTHERAPY IN RELAPSE: ABDOMEN AND PELVIS
Radiotherapy has played a role, historically and more recently,
as salvage treatment for patients with localized relapse. Trials
comparing chemotherapy with radiotherapy in this setting report
mixed results. Some favor ongoing chemotherapy and others
suggest equivalence.11 26 The patient cohort most likely to derive
benefit is similar to the adjuvant setting. Schray et al reported an
improvement in median 3-­year disease-­free survival rates with
salvage radiotherapy from 35% to more than 50% for patients with
low grade tumors and <2 cm residuum compared with high-­risk
patients with macroscopic residual disease.27
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In a retrospective series, Brown et al reviewed 102 patients with
loco-­regional ovarian cancer recurrences who received involved
field radiotherapy (45 Gy or higher). Most patients were pre-­treated
with a median of three chemotherapy cycles prior to radiotherapy.
Five-­year overall and progression-­free survival rates after involved
field radiotherapy were 40% and 24%, respectively. A sub-­set of
patients (35%) remained disease-­free at 28-­month follow-­up. The
eight patients with clear cell carcinoma had the best outcomes:
5-­year overall survival 88% versus 37% (p=0.05) and progression-­
free survival 75% versus 20% (p=0.01).28
Another of the retrospective single-­center trials analyzed 40
patients treated with salvage radiotherapy for a localized recur-
rence (45% pelvic, 35% nodal, and 8% vaginal). Prior to radio-
therapy, 60% underwent cytoreductive surgery. The median time
to relapse following radiotherapy was 16 months with a 3-­year
disease-­free survival rate of 18% and an overall survival rate of
80%. Most relapses occurred outside the radiation field. Patients
with non-­ serous histology and those with platinum-­ sensitive
disease had the best disease-­free survival outcomes.29
Non-­serous histology, namely endometrioid, was again noted
to be a favorable prognostic feature in a trial by Rome et al who
reported significantly longer disease-­free survival rates for patients
receiving radiotherapy for recurrent or persistent tumors compared
with other histological sub-­types (p=0.017).30 This finding was
replicated in a study by Swenerton et al who examined the use of
radiotherapy after surgery and chemotherapy. Patients with stage
I and II disease and non-­serous histology had a 40% reduction in
disease-­specific mortality and a 43% reduction in overall mortality.
This was in contrast to those patients with serous histology who
derived no benefit in the trial from the addition of radiation.31
Despite the potential benefits of salvage radiation, the high
rates of bowel toxicity (particularly following multiple previous

Figure 2 Stereotactic ablative radiotherapy using a Cyberknife to a solitary bone metastasis. Multiple beams are used to
create a highly conformal radiotherapy plan. Note how the radiation dose is shaped to avoid the spinal cord and kidneys.
laparotomies) and the risks of myelosuppression (due to irradiation
of the bone marrow in a patient population pre-­treated with chemo-
therapy) are significant. Although involved field radiotherapy has a
lower bowel toxicity rate than whole abdominal radiotherapy, a trial
combining radiotherapy to the pelvis alone and radiotherapy to the
abdomen and pelvis combined reported rates of up to 21.7% grade
3 or 4 bowel toxicity requiring surgery.30
Given that radiotherapy is unlikely to be curative in the salvage
setting for patients with more advanced residual disease, the risk of
significant toxicity needs to be carefully considered.
RADIOTHERAPY IN RELAPSE: STEREOTACTIC RADIOTHERAPY
Stereotactic radiotherapy is one of the most important develop-
ments in radiotherapy delivery over the last decade. It is an ultra-­
conformal technique which enables a very high dose of radiation to
be targeted on a tumor with relatively little irradiation of surrounding
healthy tissues (Figure 2). It is used in the primary setting for the
treatment of lung cancer and, more widely, in many other tumor
types for local recurrence and oligometastatic disease (defined as
1–5 discrete metastatic deposits). It has potential in the treatment
of ovarian cancer which has relapsed locally but may not be surgi-
cally accessible.
In the salvage setting, the high dose per fraction of radiation
can achieve impressive local control rates and can be delivered to
patients who have received prior radiation therapy. In comparison
with whole abdominal radiotherapy and pelvic nodal radiotherapy,
acute and long-­term toxicity rates are lower.32 It may be considered
for localized relapse, nodal disease, or distant metastases.
One of the largest clinical trials demonstrating benefit for
stereotactic radiotherapy in oligometastatic disease was the inter-
national SABR-­COMET trial which showed a significant overall
survival benefit when treating patients with 1–5 metastases with
Durno K, Powell ME. Int J Gynecol Cancer 2022;32:366–371. doi:10.1136/ijgc-2021-002462
Review
Int J Gynecol Cancer: first published as 10.1136/ijgc-2021-002462 on 7 March 2022. Downloaded from http://ijgc.bmj.com/ on March 16, 2022 at Hospital Fundación Jiménez Díaz G3.
stereotactic radiotherapy plus standard of care compared with
standard of care alone.33
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A single-­center study of 82 patients with ovarian cancer with
oligorecurrent or oligoprogressive disease during or following
chemotherapy, for whom further surgery was unsuitable, were
treated with stereotactic radiotherapy with a median dose of
24 Gy in three fractions. Around half went on to have subsequent
chemotherapy with a median systemic treatment-­free period of
7.4 months post radiotherapy. Evaluating all treated lesions, 60%
showed a complete response, 17% a partial response, 16% had
stable disease, and only 7% had progressive disease. No grade
3 or 4 toxicities were recorded. The trial reported overall survival
rates of 71% at 2 years with a pattern of failure typically outside of
the radiation field, suggesting stereotactic radiotherapy offers good
local control rates with minimal toxicity and may delay the time for
subsequent lines of chemotherapy.34
In 2020, Kowalchuk et al published a retrospective analysis of
35 ovarian cancer patients with 98 treated lesions to review the
toxicity and outcomes of stereotactic radiotherapy in ovarian cancer.
They drew similar conclusions to previous studies, that stereotactic
radiotherapy was safe with only one toxicity greater than grade 2
(grade 5 late bowel toxicity with gastrointestinal bleeding) and also
effective, with 2-­year local control rates of 80%.35
The excellent rates of local control with stereotactic radiotherapy
in oligometastatic gynecological malignancy is promising for the
future; however, significant rates of disease progression outside of
the radiation field still exist (79–100% of failures). For this reason,
careful consideration and patient selection is required to decide
whether to treat nodal recurrences with highly focal stereotactic
radiotherapy or a more extensive involved field radiation which runs
the risk of greater toxicity.36
Stereotactic radiotherapy and radiosurgery have also been used
to treat brain metastases in ovarian cancer and have been shown to
369
Review
improve overall survival compared with whole brain radiotherapy,
with a median overall survival of 29 months compared with 6
months.37
Despite possible benefit in both local and distant recurrence, the
integration of stereotactic radiotherapy within the ovarian cancer
treatment pathway has yet to be firmly established.
PALLIATIVE RADIOTHERAPY
Although the introduction of platinum chemotherapy largely
removed radiotherapy from the adjuvant setting in ovarian cancer,
it remains beneficial in the palliative setting. Of 44 trial patients
receiving palliative radiotherapy for recurrent epithelial ovarian
cancer (with prior surgery and platinum-­based chemotherapy), the
1-­year in field local control rate was 66%. The trial included patients
treated with radiotherapy to any site including whole brain radio-
therapy, and included a combination of fractionations. A biologically
equivalent dose of more than 50 Gy was associated with improved
outcomes, even in patients with platinum refractory disease.38
Palliative radiotherapy may be considered in several situations
but predominantly for symptom control, and in particular pain and
bleeding. To evaluate which patients may derive benefit from pallia-
tive radiotherapy, Jiang et al reviewed 64 patients with a symptom-
atic ovarian cancer recurrence treated with a total of 76 courses of
radiotherapy over an 11-­year period. Those patients treated for pain
and bleeding had the highest rates of partial or complete response,
93% for bleeding and 87% for pain. Overall symptomatic benefit
was independent of total radiotherapy dose or platinum sensitivity.39
Comparative responses were seen in an earlier study by Tinger et al
who reported an overall response rate for palliation of all symptoms
of 73% with a median response duration of 9 months.40
DISCUSSION AND FUTURE CONSIDERATIONS
There are technical challenges associated with the delivery of radi-
otherapy to the whole abdomen, not least the toxicity rates and
the challenge of keeping the radiation dose to surrounding normal
tissue (small bowel, kidneys, liver, and lung bases) to a safe level
while delivering a sufficient dose to tumor cells. Although rare,
the risk of radiation-­induced cancer must also be considered in
those patients who are likely to achieve cure. With a lack of high-­
quality phase III randomized controlled trials, the role of adjuvant
abdominal and pelvic radiotherapy is poorly defined and, based on
current evidence, unlikely to be beneficial. Further consideration
and prospective evaluation should, however, be given to treating a
sub-­set of patients with ovarian clear cell carcinoma with interme-
diate grade stage IC–III disease. Most relapses in this group occur
in the pelvis, therefore adjuvant pelvic nodal radiotherapy with IMRT
rather than conformal whole abdominal radiotherapy to achieve a
compromise between reducing recurrence and limiting toxicity
may be considered. Due to the relative rarity of clear cell ovarian
cancer, any prospective trial to collect high quality evidence for this
practice would require international collaboration for sufficient and
timely patient recruitment.
Radiotherapy has also shown promise in the salvage setting
for oligometastatic and oligorecurrent disease. The use of stereo-
tactic radiotherapy for isolated, low volume, non-­operable relapses
370 Durno K, Powell ME. Int J Gynecol Cancer 2022;32:366–371. doi:10.1136/ijgc-2021-002462
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provides significant long-­term disease-­free survival benefit with
minimal reported toxicity. There is ample evidence to recommend
radiotherapy for symptomatic benefit for patients in the palliative
setting where its rates of control of pain and bleeding are high.41
Looking forward to the future, radiotherapy may be combined
with other systemic therapies as a means to try and exploit the
abscopal effect. Immunotherapy has rapidly emerged and revo-
lutionized treatment in many cancers, with melanoma, renal and
lung cancer leading the way. Its benefit in ovarian cancer is less
well established, with trials demonstrating response rates to single
agent checkpoint inhibitors of between 6% and 15%.42 Future trials
combining the synergistic effects of radiation and immunotherapy
in ovarian cancer may show improved response rates compared
with these therapies individually.43
Additional targeted treatments such as PARP inhibitors also play
an important role in a sub-­set of patients with ovarian cancer. The
combination of these alongside radiotherapy has been evaluated in
early phase trials in other tumor types and this may also be a future
direction of study for ovarian cancer research .44 45
CONCLUSION
Considering the evidence, there is currently no clear role for whole
abdominal radiotherapy in the adjuvant setting for patients with
ovarian cancer, even with the use of IMRT to minimize toxicity.
espite this, radiotherapy should not be dismissed. Within the
Protected by copyright.
palliative, salvage, and oligometastatic settings, radiotherapy has
a significant role to play. Not only can it improve local control for
isolated relapses, it can also provide key symptomatic benefit for
patients.
Twitter Melanie E Powell @DrMelaniePowell
Contributors KD and MP both researched and wrote this review.
Funding The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not-­for-­profit sectors.
Competing interests None declared.
Patient consent for publication Not applicable.
Ethics approval This study does not involve human participants.
Provenance and peer review Commissioned; internally peer reviewed.
ORCID iD
Melanie E Powell http://orcid.org/0000-0002-9850-8181
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