External beam radiation with 'curative intent' in advanced ovarian cancer: An uncommon but rational management approach based on the natural history of cancer in an individual patient

摘要

On the surface, it is difficult to think of a setting where the concept of the delivery of external beam radiation with 'curative intent' would be more inappropriate. Advanced ovarian cancer is recognized to be widespread throughout the peritoneal cavity in the large majority of patients at diagnosis. In fact, the rationale for considering 'stage 2' ovarian cancer as an objectively valid clinical entity has been questioned, suggesting that, in the large majority of cases, one is really dealing with 'stage 3' disease even though it is not possible to confirm (during surgery) the presence of micro-metastatic disease in the upper abdomen. Furthermore, the statistically more favorable outcome for such patients (stage 2), compared to women who present with documented metastatic disease outside the pelvis, is likely the result of the presence of a substantially reduced tumor bulk rather than being due to the specific anatomic localization of the cancer.