Vienna, Austria

ESTRO 2023

Session Item

May 15
10:30 - 11:30
Business Suite 1-2
Pelvic cancers
Li Tee Tan, United Kingdom
Poster Discussion
Pilot study on carbon-ion radiotherapy for recurrent/refractory ovarian/salpinx cancer
Amelia Barcellini, Italy


Pilot study on carbon-ion radiotherapy for recurrent/refractory ovarian/salpinx cancer

Amelia Barcellini1, Kazutoshi Murata2, Giulia Fontana3, Angelica Ghirelli1, Alessandro Vai4, Silvia Molinelli4, Chiara Cassani5, Simona Secondino6, Guido Baroni7, Nadia Facchinetti8, Shigeru Yamada2, Noriyuki Okonogi2, Ester Orlandi1

1CNAO National Center for Oncological Hadrontherapy, Radiation Oncology Unit, Clinical Department, Pavia, Italy; 2QST Hospital, National Institutes for Quantum Science and Technology, Radiation Oncology Unit, Chiba, Japan; 3CNAO National Center for Oncological Hadrontherapy, Clinical Bioengineering Unit, Clinical Department , Pavia, Italy; 4CNAO National Center for Oncological Hadrontherapy, Medical Physics Unit, Clinical Department, Pavia, Italy; 5Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, and Unit of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; 6IRCCS Policlinico San Matteo Foundation, Medical Oncology, Pavia, Italy; 7Department of Electronics, Information and Bioengineering, Politecnico di Milano , and CNAO National Center for Oncological Hadrontherapy,Clinical Bioengineering Unit, Clinical Department, Milano, Pavia, Italy; 8CNAO National Center for Oncological Hadrontherapy , Scientific Direction, Pavia, Italy

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Purpose or Objective

To analyze the real‐world data set of the recurrent/refractory ovarian/salpinx cancer (RR‐OSC) treated with carbon ion radiotherapy (CIRT) at QST (Japan) and CNAO (Italy).

Material and Methods

CIRT for RR-OSC commenced in 2006 at QST and in 2019 at CNAO. The endpoints of this preliminary analysis were the rate of objective response (OR) to CIRT, 1 and 2-years local control (LC) rates and acute/late toxicities. OR was defined as the sum of complete response (CR) and partial response (PR). According to centre policy, toxicity was scored using RTOG/EORTC and CTCAE scales. Actuarial outcomes were evaluated using the Kaplan-Meier method and the impact of dose (>/≤ 52.8 Gy[RBE]), age (>/≤ 60 years), tumor site (lymph node/parenchymal), ethnicity (Asian/Caucasian) on LC survival using log-rank test/multivariable Cox regression analysis. Univariable logistic regression was employed to assess the statistically significant parameters’ relationship with OR (α=0.05).


A total of 26 women (58% Asian and 42% Caucasian) underwent CIRT for RR-OSC. All patients completed the treatment. 21 patients were radiotherapy naïve, while 5 patients received a previous photon beam treatment. The median age at CIRT was 59.5 years (range:44-81) and the most common histological type was high-grade serous carcinoma (42%). All patients underwent at least 1 cytoreductive surgery and at least 1 previous line of chemotherapy. The median total dose prescription was 52.8 Gy[RBE] (range:39-64 Gy[RBE]). No concomitant systemic therapies were administered during CIRT; PARP-I and anti-VEGF were stopped before CIRT. Lymph node lesions accounted for 54% (N=14), followed by parenchymal ones (abdominal=7;pelvic=4,brain=1, for a total of 46%). Eleven (42%) patients achieved CR within 6 months after CIRT. With a median follow-up of 13 months, the OR was 85% and only 4 (15%) patients had an in-field local recurrence. The median LC was 12 months (range 2-193), and the 1- and 2-year LC rates were 89% and 74% respectively. Total dose (p=0.63), age (p=0.35), CIRT site (p=0.46) and ethnicity (p=0.68) were not significantly associated with LC. These items were not related to OR either. Only one case of G3 EORTC/RTOG enterocolitis in the acute and late phases was observed. No G≥3 toxicities were recorded in re-irradiated patients. Six patients received PARP-i and 4 anti-VEGF, which seemed not to exacerbate the risk of severe toxicities.


Our real-world data showed for the first time the efficacy and safety of CIRT in patients with RR‐OSC, even in the case of re-irradiation. Considering its dosimetric and radiobiological advantages, CIRT might be a therapeutic option for RR-OSC, with the aim also to delay a new chemotherapy line. Prospective and randomized studies are warranted.