Efficacy of radiotherapy for ovarian ablation

Results of a Breast Intergroup study

Authors

  • Lorie L. Hughes M.D.,

    Corresponding author
    1. Department of Radiation Oncology, WellStar Kennestone Hospital, Marietta, Georgia
    • Department of Radiation Oncology, WellStar Kennestone Hospital, 55 S. Medical Drive, Suite 100, Marietta, GA 30060
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    • Fax: (770) 793-7985

    • The authors appreciate the assistance of Nicole Williams (Eastern Cooperative Oncology Group Operations Office) and Gerald Feuer, M.D., in the preparation of this article.

  • Robert J. Gray Ph.D.,

    1. Department of Biostatistic Science, Dana Farber Cancer Institute, Boston, Massachusetts
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    • The authors appreciate the assistance of Nicole Williams (Eastern Cooperative Oncology Group Operations Office) and Gerald Feuer, M.D., in the preparation of this article.

  • Lawrence J. Solin M.D.,

    1. Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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    • The authors appreciate the assistance of Nicole Williams (Eastern Cooperative Oncology Group Operations Office) and Gerald Feuer, M.D., in the preparation of this article.

  • Nicholas J. Robert M.D.,

    1. Fairfax Northern Virginia Hematology Oncology Practice, Vienna, Virginia
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    • The authors appreciate the assistance of Nicole Williams (Eastern Cooperative Oncology Group Operations Office) and Gerald Feuer, M.D., in the preparation of this article.

    • Dr. Nicholas J. Robert has acted as a consultant and speaker for Astra Zeneca.

  • Silvana Martino D.O.,

    1. John Wayne Cancer Institute, Santa Monica, California
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    • The authors appreciate the assistance of Nicole Williams (Eastern Cooperative Oncology Group Operations Office) and Gerald Feuer, M.D., in the preparation of this article.

  • Debu Tripathy M.D.,

    1. University of Texas Southwest Medical Center, Dallas, Texas
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    • The authors appreciate the assistance of Nicole Williams (Eastern Cooperative Oncology Group Operations Office) and Gerald Feuer, M.D., in the preparation of this article.

  • James N. Ingle M.D.,

    1. Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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    • The authors appreciate the assistance of Nicole Williams (Eastern Cooperative Oncology Group Operations Office) and Gerald Feuer, M.D., in the preparation of this article.

  • William C. Wood M.D.,

    1. Emory University Hospital, Atlanta, Georgia
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    • The authors appreciate the assistance of Nicole Williams (Eastern Cooperative Oncology Group Operations Office) and Gerald Feuer, M.D., in the preparation of this article.

  • For the Eastern Cooperative Oncology Group,

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    • This study was coordinated by the Eastern Cooperative Oncology Group (Robert L. Comis, M.D., Chair) and supported in part by Public Health Service Grants CA22318, CA32102, CA11789, CA31946, CA13650, CA66636, and CA21115 and from the National Cancer Institute, National Institutes of Health, and the Department of Health and Human Services.

  • the Southwest Oncology Group,

  • Cancer and Leukemia Group B,

  • and The North Central Cancer Treatment Group


  • The contents of the current study are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

  • Presented as a poster presentation at the 22nd Annual San Antonio Breast Cancer Symposium, December X–X, 1999.

Abstract

BACKGROUND

In 1994, the Eastern Cooperative Oncology Group (ECOG) initiated for the Breast Intergroup a randomized clinical trial (E3193) in premenopausal patients with early-stage breast carcinoma (lymph node-negative and receptor-positive, with tumors measuring ≤ 3 cm) comparing tamoxifen as adjuvant systemic therapy with tamoxifen and ovarian ablation by one of three different methods. Ovarian ablation could be accomplished either via radiotherapy (RT) (20 Gray [Gy]/10 fractions to a modified pelvic volume), surgical oophorectomy, or goserelin/leuprolide injections as per patient/physician choice. In the current study, we report the efficacy of pelvic RT with this dose-fractionation scheme in the induction of ovarian ablation.

METHODS

Twenty-two of 174 patients (13%) who were randomized to treatment with tamoxifen and ovarian ablation received RT for ovarian ablation. RT quality assurance was performed. Of the 22 patients, 19 were treated per protocol, 1 patient had a minor violation (20 elapsed days for 10 RT fractions), and 2 patients had major violations (1 patient who was treated with RT as per protocol but who was treated at a non-Intergroup center, and 1 patient who was treated at a dose of 15 Gy/5 fractions).

RESULTS

No acute Grade 3 or 4 (according to the Common Toxicity Criteria of the National Cancer Institute) toxicities were reported during RT. Of the 22 patients receiving RT, evaluable follow-up data were available for 20 patients. Based on postmenopausal levels of estradiol or follicle-stimulating hormone at varying intervals after the completion of RT, 15 of 20 patients (75%) achieved successful ovarian ablation with RT. At a median follow-up of 54 months (range, 21–66 months), no Grade 3 or 4 complications from RT were observed.

CONCLUSIONS

Ovarian ablation by RT as performed in the current trial (given at a dose of 20 Gy in 10 fractions to a modified pelvic treatment volume) was found to be effective for ovarian ablation in the majority of patients, but may take some months to be complete. Consequently, patients should be evaluated to ascertain that ablation has been accomplished. Cancer 2004. © 2004 American Cancer Society.

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