Annual Meeting Proceedings Part 1 - American Society of Clinical ...

348s Gynecologic Cancer
5086 General Poster Session (Board #23F), Sun, 8:00 AM-12:00 PM
Concurrent chemoradiotherapy with paclitaxel and cisplatin for adenocarcinoma
of the cervix. Presenting Author: Yutaka Nagai, University of the
Ryukyus, Okinawa, Japan
Background: Adenocarcinoma of the cervix has a worse prognosis than its
squamous counterpart, particularly when cancer cells spread beyond the
uterine cervix. This is derived from the observation that adenocarcinoma is
less sensitive to radiotherapy (RT) and chemotherapy It is unclear whether
cisplatin-based concurrent chemoradiotherapy (CCRT) has the same effect
on adenocarcinoma as on squamous cell carcinoma. Methods: We retrospectively
analyzed 32 patients with stage IIB–IVA cervical adenocarcinoma
who were treated with RT or CCRT. Fourteen patients were treated with RT
from 1983–1996, 8 with CCRT using cisplatin alone (CCRT-P) from
1997–2002, and 10 with CCRT using cisplatin�paclitaxel (CCRT-TP)
after 2003. The patients were treated with external beam radiotherapy, and
low-dose or high-dose rate intracavitary brachytherapy. For CCRT-P, the
patients received 20 mg/m2 cisplatin for 5 days every 3 weeks, and for
CCRT-TP, the patients received 50 mg/m2 cisplatin every 3 weeks and 50
mg/ m2 paclitaxel weekly. Results: A complete response was achieved in
7/14 patients in the RT, 4/8 patients in the CCRT-P, and 9/10 patients in
the CCRT-TP group. Ten of the 14 patients in the RT, 7/8 patients in the
CCRT-P, and 2/10 patients in the CCRT-TP group experienced locoregional
recurrence. The 5-year overall survival rate in the RT, CCRT-P, and
CCRT-TP groups was 7.1%, 25.0%, and 74.1%, respectively (p �
0.0094), and their central disease-free survival rate was 21.4%, 12.5%,
and 78.8%, respectively (p�0.0119). The acute toxicities associated with
CCRT-TP are manageable. Regarding late toxicity of CCRT-TP, no grade 3/4
adverse effect was observed. Conclusions: The present study demonstrated
that CCRT-TP achieved much better local control for adenocarcinoma of
the cervix, leading to a decrease in locoregional recurrence. Prospective
trials in larger series of patients are urgently needed.
5088 General Poster Session (Board #23H), Sun, 8:00 AM-12:00 PM
The impact of racial disparity on outcomes of patients with early-stage
uterine endometrioid carcinoma in an equal-access environment. Presenting
Author: Jared R. Robbins, Henry Ford Hospital, Detroit, MI
Background: To determine if racial disparity exists between African American
(AA) and non-African American (NAA) patients with early stage uterine
endometrioid carcinoma who had similar multidisciplinary management.
Methods: Our prospectively-maintained database of 1,450 uterine cancer
patients was reviewed for this IRB-approved study. We identified 766
consecutive patients with endometrioid carcinoma 1988 FIGO stages I-II
who underwent hysterectomy between 1987-2009. Patients with nonendometrioid
carcinoma, mixed histologies and those who received preoperative
treatments were excluded. For the purpose of data analysis, patients
were divided into two groups; AA and NAA. Recurrence-free survival (RFS),
disease specific (DSS) and overall survival (OS) was calculated from the
date of hysterectomy using the Kaplan-Meier method. Cox regression
modeling was used to explore the risks of various factors on recurrence.
Results: Median follow-up was 5.1 years. 27% were AA and 73% were NAA.
All patients underwent hysterectomy and oophorectomy. 80% had peritoneal
cytology and 69% underwent lymphadenectomy. AA patients were
more likely to have higher grade tumors, and more lymphovascular space
involvement (LVSI). Although the two groups were balanced in regards to
surgical staging and adjuvant treatment received, the five-year RFS and
DSS were significantly lower in AA compared to NAA patients (91% vs
84%, p�0.030; 95% vs 88%, p�0.011, respectively). Between the two
groups, OS was not significantly different. On multivariate analysis and
after adjusting for other prognostic factors, race (AA vs NAA) was not a
significant predictor of outcome. Grade 3 tumors and the presence of LVSI
were the only two independent predictors of RFS and DSS with p��0.001
and p��0.001, respectively. Conclusions: In this large hospital-based
study, AA race was associated with a higher incidence of adverse pathological
features and worse recurrence-free and disease-specific survival.
However, on multivariate analysis race was not an independent prognostic
factor. Further studies are needed to elucidate possible underlying molecular
mechanisms for these poorer outcomes.
5087 General Poster Session (Board #23G), Sun, 8:00 AM-12:00 PM
How is the current clinical management of endometrial cancer worldwide?
An international survey by the North-Eastern German Society of Gynaecological
Oncology (NOGGO). Presenting Author: Robert W. Kraetschell,
Charité University Department of Gynecology, Campus Virchow Clinic,
Berlin, Germany
Background: Indication, technique and extent of lymph-node-dissection
(LND) in endometrial cancer (EC) remains controversial and is strongly
debated in cancer community. We conducted a national- and at a second
step an international-survey evaluating the current status-quo of the
surgical and medical management of EC. Methods: A validated 15-itemquestionnaire
regarding surgical and adjuvant procedures of EC was sent to
all major gynaecological cancer societies and study groups worldwide. The
questionnaire could also be answered online. Results: In a phase-I-national
trial, the questionnaire was validated on basis of 316 German institutions.
On the phase-II-international survey a total of 302 questionnaires were
answered from 24 countries, mainly from Japan (38.7%), Spain (8.3%),
Austria (7%), United-Kingdom (6.3%), Italy (6%), USA (4.3%) and
Canada (4%). The vast majority of the participating clinics were academic
(62.8%), while 75.2% of them belonged to gynaecology. Only 0.7% of the
clinics internationally reported never performing LND in EC. 62.3% of the
clinics perform both a pelvic and paraaortic lymph node dissection. 59.1%
of the participants performed a systematic lymph node dissection with the
intention of both adequate staging and for therapeutic value. 15.05% of
the clinics perform LND up to the common-iliac-arteries, 9.03% up to the
inferior-mesenteric-artery and 70.6% up to the renal-veins. The most
common risk-factors to indicate LND were: high-grading (93%), nonendometrioid-histology
(90.1%), lymphovascular-invasion (55.3%), bloodvessel
invasion (45.4%) and tumor-diameter �2cm (38.4%). For advanced
stage III&IV disease the vast majority (60% and 80%, respectively) of the
physicians indicated systemic chemotherapy alone. Conclusions: This study
presents the large variety in clinical management of EC worldwide,
underlining so the high need of future prospective randomised trials which
will establish standard and evidence based treatment guidelines for ECdisease.
5089 General Poster Session (Board #24A), Sun, 8:00 AM-12:00 PM
Association of smoking with pulmonary recurrences among women with
intermediate- to high-risk early-stage endometrial adenocarcinoma. Presenting
Author: Lori Elizabeth Weinberg, Case Comprehensive Cancer Center
and Case Western Reserve University, Cleveland, OH
Background: While a number of histologic risk factors have been identified
in endometrial carcinoma, host factors are less well studied. Our aim was to
examine the influence of smoking on the risk of pulmonary recurrences in
women with early stage intermediate to high-risk endometrioid uterine
cancer (EC). Methods: Women with surgically treated stage I or II EC from
1994 to 2010 were included in this study if they had lymphovascular space
invasion (LVSI), FIGO grade 2 or 3 histology (G2/3), or outer half
myometrial invasion (OI). All demographic, medical and oncologic data
were obtained from chart review. Patients were excluded if their follow-up
period was less than six months or if they had a diagnosis of a second
primary invasive cancer. We performed univariate and multivariate logistic
regression analyses and Fisher’s Exact test for two-way analyses of
categorical variables to identify prognostic factors of pulmonary recurrences.
Significance was determined by two-sided tests with ��0.05.
Results: 349 patients were identified to meet histologic criteria, 3% were
excluded. The remaining 337 patients had a median follow-up of 60
months (range 6 to 194). The median age of this cohort was 68 years and
median BMI was 30.7 kg/m2. 81 patients (24%) had a past or present
history of smoking. There were 14 pulmonary recurrences (4.1%), 36
(10.7%) distant recurrences and 58 (17.2%) total recurrences in the
cohort. Smoking (present or past) was significantly associated with pulmonary
recurrences, with an odds ratio of 1.09 (95% CI 1.04-1.15;
P�0.0002). In a multivariate analysis adjusting for age, BMI, grade, LVSI,
OI, cervical invasion, and adjuvant therapy, smoking was still a predictor of
pulmonary recurrences. Conclusions: Smoking is a significant and independent
predictor of pulmonary recurrences among women with early stage EC.
Refining our understanding of host factors that influence risk may further
allow us to identify those who may benefit most from adjuvant therapies as
well as intensive surveillance.
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