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IB2 cervical carcinoma: Outcomes by primary therapy
Abstracts
experienced disease recurrence. Median time to recurrence was 17 months (range, 7–30). Median number of chemotherapy lines was 1 (range, 0–6). Median length of follow-up was 25 months (range, 0–88). At the time of last follow-up, 82% was without evidence of disease, 2.6% was alive with disease, and 15.4% was dead of disease. Conclusion: Due to the rare occurrence of lymph node metastasis, lymphadenectomy has limited diagnostic and prognostic value with mucinous adenocarcinoma of the ovary and may introduce unnecessary morbidity, particularly in patients who require re-operation. Survival periods are unusually long with rare disease recurrence. doi:10.1016/j.ygyno.2014.07.040
Predictors of survival following recurrence of cervical cancer A. Walter, J. Lauer, C. Gunderson, K. Slaughter, L. Perry, S. McMeekin, K. Moore. University of Oklahoma Stephenson Cancer Center, USA. Objectives: Recurrent cervical cancer portends a poor prognosis. The purpose of this investigation is to identify the predictors of survival following the recurrence of cervical cancer. Methods: A retrospective chart review was performed in patients (pts) treated for cervical cancer (CXCA) from 1999 to 2011. Descriptive, clinico-pathologic, and survival data were collected. SAS 9.3 was used for statistical analyses. Results: During the 12 years of this study, 504 newly diagnosed CXCA pts were identified. 142 of the 504 patients were diagnosed with recurrence, and 128 had complete data for analysis. Univariate analysis was performed to identify potential predictors of survival; time from initial diagnosis to recurrence (dichotomized into those recurring less than 12 months of initial diagnosis and those greater than 12 months), race, smoking status, stage, BMI and histology. Significant predictors in univariate analysis were; time to recurrence HR = 1.75 (p = .0046), stage HR 1.13 (p = .0033), and squamous histology HR = 1.59 (p = .03). These were then evaluated in a multivariate model, only time to recurrence less than 12 months HR = 1.59 (p = .02) and stage HR 1.11 (p = .01) were predictors of death following recurrence. Conclusion: In multivariate analysis stage and time to recurrence of less than 12 months from initial diagnosis are independent predictors of death following recurrence of cervical carcinoma. Overall, survival remains poor in patients with recurrent cervical carcinoma; patients with long interval from diagnosis to recurrence and early stage may be more likely to benefit from aggressive therapy following recurrence. doi:10.1016/j.ygyno.2014.07.041
IB2 cervical carcinoma: Outcomes by primary therapy A. Walter, C. Gunderson, K. Slaughter, L. Perry, S. McMeekin, K. Moore. University of Oklahoma Stephenson Cancer Center, USA. Objectives: Most IB2 cervical carcinomas are treated with primary platinum-based chemotherapy with concurrent radiation (CRT); however, radical hysterectomy (RH) remains an option for some. The purpose of this investigation is to compare baseline demographic and treatment outcomes. Methods: A retrospective chart review was performed in patients (pts) treated for cervical cancer (CXCA) from 1999 to 2011. Descriptive, clinico-pathologic, and survival data were collected. SAS 9.3 was used for statistical analyses. Results: During the 12 years of this study, 504 newly diagnosed CXCA pts were identified. 71 of the 504 patients were identified with IB2 disease; detailed treatment information was available for 65; they are the focus of this study. 30 patients were prescribed CRT as
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primary therapy, and RH was performed for 35 patients. There was no difference between the two groups in terms of BMI, smoking status, race, insurance status, and histology. The CRT group was significantly older (median age: 49 vs. 43 years, p = .02) and had higher grade histology (p = .04). There were no significant differences in post-treatment complications including rates of venous thromboembolism, transfusions, ER visits, or hospital readmission within 60 days of treatment. Overall survival (3.46 vs. 7.94 years p = .37) and progression free survival were not different between CRT and RH at 3.03 years vs 4.89 years respectively (p = .47), and recurrence rates were similar (40% CRT vs 37% RH). Of the 35 patients in the RH group, 27 (74%) were treated with adjuvant therapy for high or intermediate risk factors. Conclusion: Patients with IB2 cervical carcinoma treated with radical surgery or primary CRT had similar outcomes in PFS, OS, and recurrence rates. The rate of adjuvant therapy is high in the RH group; however, this did not translate to increased short term morbidity. Knowledge of differences in long-term toxicity would be crucial to selecting therapies for these patients in an evidence-based manner. doi:10.1016/j.ygyno.2014.07.042
Are current treatments effective, in gynecologic cancer patients with central nervous system metastasis? A. Walter, C. Guderson, K. Slaughter, L. Perry, S. Mcmeekin, K. Moore. University of Oklahoma Stephenson Cancer Center, USA. Objectives: CNS metastasis with gynecologic malignancy is a rare event associated with poor prognosis; fewer than 30% survive N12 months. Palliative treatment is often used, with cerebral tumor control and prevention of CNS recurrence the primary outcome. We evaluated various treatment strategies in the gynecologic cancer population. Methods: An IRB-approved retrospective chart review was performed identifying all patients diagnosed with a primary gynecologic malignancy treated for CNS metastasis from 2005 to 2014 at a single academic center. SAS 9.3 was used for statistical analyses. Results: Thirty-five patients were identified. Median age was 61 years (range, 41–79). The majority had ovarian cancer (54%), 37% endometrial cancer, and 9% squamous cell cervical cancer. 57% of patients were treated with whole brain radiation therapy (WBRT), 14% stereotactic radiosurgery alone (SRS), 14% combined surgery and SRS, 6% combined SRS + WBRT, and 2 patients hospice. 17% had a CNS recurrence; 60% of patients initially treated with surgery + SRS recurred, 10% initially treated with WBRT recurred, and 20% treated with SRS only recurred. There was non-significant trend in recurrence risk in patients receiving directed therapy 10% vs. 31% (p = .1307). All patients had Karnofsky performance status N80; number of CNS lesions, histologic type and presence of extra-cranial disease were not associated with recurrence. Of the 6 patients that recurred, 4 had re-treatment with WBRT and achieved CNS tumor control; 2 patients elected for hospice. All patients that received locally directed therapy were salvaged. Conclusion: Treatment of CNS metastases varies widely, with local treatment strategies failing more frequently. Despite recurrences in nearly one-fifth of patients, salvage therapy is successful with multiple treatment strategies effectively achieving palliation. doi:10.1016/j.ygyno.2014.07.043
Even high risk women lack knowledge of obesity's impact on risk for endometrial cancer A. Beavisa,b, S. Cheemac, C. Holschneiderb, E. Duffya, M. Amneusb. a David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, bOlive ViewUCLA Medical Center, Sylmar, CA, USA, cUCLA School of Public Health, USA.
experienced disease recurrence. Median time to recurrence was 17 months (range, 7–30). Median number of chemotherapy lines was 1 (range, 0–6). Median length of follow-up was 25 months (range, 0–88). At the time of last follow-up, 82% was without evidence of disease, 2.6% was alive with disease, and 15.4% was dead of disease. Conclusion: Due to the rare occurrence of lymph node metastasis, lymphadenectomy has limited diagnostic and prognostic value with mucinous adenocarcinoma of the ovary and may introduce unnecessary morbidity, particularly in patients who require re-operation. Survival periods are unusually long with rare disease recurrence. doi:10.1016/j.ygyno.2014.07.040
Predictors of survival following recurrence of cervical cancer A. Walter, J. Lauer, C. Gunderson, K. Slaughter, L. Perry, S. McMeekin, K. Moore. University of Oklahoma Stephenson Cancer Center, USA. Objectives: Recurrent cervical cancer portends a poor prognosis. The purpose of this investigation is to identify the predictors of survival following the recurrence of cervical cancer. Methods: A retrospective chart review was performed in patients (pts) treated for cervical cancer (CXCA) from 1999 to 2011. Descriptive, clinico-pathologic, and survival data were collected. SAS 9.3 was used for statistical analyses. Results: During the 12 years of this study, 504 newly diagnosed CXCA pts were identified. 142 of the 504 patients were diagnosed with recurrence, and 128 had complete data for analysis. Univariate analysis was performed to identify potential predictors of survival; time from initial diagnosis to recurrence (dichotomized into those recurring less than 12 months of initial diagnosis and those greater than 12 months), race, smoking status, stage, BMI and histology. Significant predictors in univariate analysis were; time to recurrence HR = 1.75 (p = .0046), stage HR 1.13 (p = .0033), and squamous histology HR = 1.59 (p = .03). These were then evaluated in a multivariate model, only time to recurrence less than 12 months HR = 1.59 (p = .02) and stage HR 1.11 (p = .01) were predictors of death following recurrence. Conclusion: In multivariate analysis stage and time to recurrence of less than 12 months from initial diagnosis are independent predictors of death following recurrence of cervical carcinoma. Overall, survival remains poor in patients with recurrent cervical carcinoma; patients with long interval from diagnosis to recurrence and early stage may be more likely to benefit from aggressive therapy following recurrence. doi:10.1016/j.ygyno.2014.07.041
IB2 cervical carcinoma: Outcomes by primary therapy A. Walter, C. Gunderson, K. Slaughter, L. Perry, S. McMeekin, K. Moore. University of Oklahoma Stephenson Cancer Center, USA. Objectives: Most IB2 cervical carcinomas are treated with primary platinum-based chemotherapy with concurrent radiation (CRT); however, radical hysterectomy (RH) remains an option for some. The purpose of this investigation is to compare baseline demographic and treatment outcomes. Methods: A retrospective chart review was performed in patients (pts) treated for cervical cancer (CXCA) from 1999 to 2011. Descriptive, clinico-pathologic, and survival data were collected. SAS 9.3 was used for statistical analyses. Results: During the 12 years of this study, 504 newly diagnosed CXCA pts were identified. 71 of the 504 patients were identified with IB2 disease; detailed treatment information was available for 65; they are the focus of this study. 30 patients were prescribed CRT as
395
primary therapy, and RH was performed for 35 patients. There was no difference between the two groups in terms of BMI, smoking status, race, insurance status, and histology. The CRT group was significantly older (median age: 49 vs. 43 years, p = .02) and had higher grade histology (p = .04). There were no significant differences in post-treatment complications including rates of venous thromboembolism, transfusions, ER visits, or hospital readmission within 60 days of treatment. Overall survival (3.46 vs. 7.94 years p = .37) and progression free survival were not different between CRT and RH at 3.03 years vs 4.89 years respectively (p = .47), and recurrence rates were similar (40% CRT vs 37% RH). Of the 35 patients in the RH group, 27 (74%) were treated with adjuvant therapy for high or intermediate risk factors. Conclusion: Patients with IB2 cervical carcinoma treated with radical surgery or primary CRT had similar outcomes in PFS, OS, and recurrence rates. The rate of adjuvant therapy is high in the RH group; however, this did not translate to increased short term morbidity. Knowledge of differences in long-term toxicity would be crucial to selecting therapies for these patients in an evidence-based manner. doi:10.1016/j.ygyno.2014.07.042
Are current treatments effective, in gynecologic cancer patients with central nervous system metastasis? A. Walter, C. Guderson, K. Slaughter, L. Perry, S. Mcmeekin, K. Moore. University of Oklahoma Stephenson Cancer Center, USA. Objectives: CNS metastasis with gynecologic malignancy is a rare event associated with poor prognosis; fewer than 30% survive N12 months. Palliative treatment is often used, with cerebral tumor control and prevention of CNS recurrence the primary outcome. We evaluated various treatment strategies in the gynecologic cancer population. Methods: An IRB-approved retrospective chart review was performed identifying all patients diagnosed with a primary gynecologic malignancy treated for CNS metastasis from 2005 to 2014 at a single academic center. SAS 9.3 was used for statistical analyses. Results: Thirty-five patients were identified. Median age was 61 years (range, 41–79). The majority had ovarian cancer (54%), 37% endometrial cancer, and 9% squamous cell cervical cancer. 57% of patients were treated with whole brain radiation therapy (WBRT), 14% stereotactic radiosurgery alone (SRS), 14% combined surgery and SRS, 6% combined SRS + WBRT, and 2 patients hospice. 17% had a CNS recurrence; 60% of patients initially treated with surgery + SRS recurred, 10% initially treated with WBRT recurred, and 20% treated with SRS only recurred. There was non-significant trend in recurrence risk in patients receiving directed therapy 10% vs. 31% (p = .1307). All patients had Karnofsky performance status N80; number of CNS lesions, histologic type and presence of extra-cranial disease were not associated with recurrence. Of the 6 patients that recurred, 4 had re-treatment with WBRT and achieved CNS tumor control; 2 patients elected for hospice. All patients that received locally directed therapy were salvaged. Conclusion: Treatment of CNS metastases varies widely, with local treatment strategies failing more frequently. Despite recurrences in nearly one-fifth of patients, salvage therapy is successful with multiple treatment strategies effectively achieving palliation. doi:10.1016/j.ygyno.2014.07.043
Even high risk women lack knowledge of obesity's impact on risk for endometrial cancer A. Beavisa,b, S. Cheemac, C. Holschneiderb, E. Duffya, M. Amneusb. a David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, bOlive ViewUCLA Medical Center, Sylmar, CA, USA, cUCLA School of Public Health, USA.