Updating the role of radiotherapy in the management of epithelial ovarian cancer

The usefulness of radiotherapy in epithelial ovarian cancer (EOC) has been questioned in recent decades, on the grounds of the outstanding performances of modern drugs in terms of immediate therapeutic results. However, complete remission of the tumour after surgery and chemotherapy does not always turn into a definitive cure, and more than 50% of the patients have a poor ultimate prognosis. Radiotherapy can still play a role in this disease, whose complexity requires a multidisciplinary approach. Principles, techniques and results of radiation therapy are outlined here, with reference to authoritative experiences. The most significant issues of the last decade are reviewed, dealing with results of radiotherapy compared with those of chemotherapy in early stages (adjuvant setting), and with multidisciplinary approaches including both drug and radiation management in high-risk or advanced presentations. There is sound and wide evidence for the efficacy of radiation therapy in EOC. Radiotherapy is a reasonable alternative to chemotherapy in the adjuvant setting (complete removal of tumour at first surgery, moderate risk for recurrence on the basis of Stage II or III presentations or histologic grade 2 or 3), and can improve the results of chemotherapy after an "optimal" response to drugs, that is, absent or minimal tumour residuals detected by clinical or surgical-pathological re-staging. In this last case, whether or not the results of the prosecution of chemotherapy are better than those of consolidation radiotherapy has not been satisfactorily demonstrated. Aspects concerning toxicity are analysed, as well as possible improvements of the results of radiotherapy.