Is Neoadjuvant Chemotherapy Feasible Prior to Intraperitoneal Chemotherapy in Women with Advanced Ovarian Cancer?

Is Neoadjuvant Chemotherapy Feasible Prior to Intraperitoneal Chemotherapy in Women with Advanced Ovarian Cancer?

366 ABSTRACTS / Gynecologic Oncology 107 (2007) 360–381 Methods. A retrospective review of cervical cancer patients identified a cohort of women ove...

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366

ABSTRACTS / Gynecologic Oncology 107 (2007) 360–381

Methods. A retrospective review of cervical cancer patients identified a cohort of women over the age of 60 with invasive cervical cancer diagnosed between January 1, 1993 and December 31, 2003. Electronic medical records and the State Tumor Registry were reviewed for age, ethnicity, cervical cancer risk factors, pathology, treatment modality, co-morbid conditions, and outcome. Results. Six hundred forty-five women with cervical cancer were identified. One hundred (15.5%) women were over the age of 60 with a median age of 64 years. Fifteen percent of these women had never had a pap smear in their life, and only 23% had a Pap smear within 5 years of diagnosis. Squamous cell carcinoma composed 74% of the pathology within the cohort. Stage distribution was 41% stage 1A1–1B1 and 59% 1B2–4B at time of diagnosis. Length of time from last Pap smear significantly correlated with stage. A radical hysterectomy was performed on 29 patients, and 15 women received adjuvant radiation. Forty-nine women were treated with primary chemotherapy and radiation, and 22 were treated with primary radiation. Lymph node metastases were identified in 32% of women who underwent lymphadenectomy. At conclusion of the study period, 77% were alive and 60% had no evidence of disease. Stage and time since last Pap smear correlated with overall outcome. Conclusions. Women over 60 make up a significant proportion of cervical cancer patients and only 23% received Pap smear in the past five years. 59% demonstrated locally advanced disease-stage 1B2 or greater. Careful consideration of these findings should be made when establishing Pap smear screening guidelines for this population of women. doi:10.1016/j.ygyno.2007.08.023

14 Is Neoadjuvant Chemotherapy Feasible Prior to Intraperitoneal Chemotherapy in Women with Advanced Ovarian Cancer? G. Barnett, A. Rogers, W. Robinson Texas Tech/Harrington Cancer Center, Amarillo, TX Objectives. Combined intraperitoneal/intravenous (IV/IP) chemotherapy has recently been shown to improve progression free and overall survival in women who have undergone optimal debulking for ovarian cancer, at the cost of increased toxicity. Neoadjuvant chemotherapy (NAC) appears to reduce surgical morbidity and may result in a higher rate of optimal debulking. This study will evaluate the morbidity and feasibility of NAC prior to attempted debulking surgery followed by IP/IV chemotherapy. Methods. Twenty-four subjects were identified between 2002–2006 with presumed stage IIIC or IV ovarian cancer, based on ascites, pelvic mass, elevated CA-125, ± pleural effusion. All subjects received three cycles of IV carboplatin/ paclitaxel. Those who responded underwent debulking surgery, and if optimally debulked were to subsequently receive six cycles of IV/IP cisplatin/paclitaxel.

Results. The average age of the subjects was 65.3 (range 40– 87). 4/24 did not undergo debulking surgery due to disease progression. 14/20 patients who underwent surgery had stage IIIC ovarian cancer, and while 6 had stage IV. Of the 20 subjects who underwent surgery, 14 met the definition of optimal disease as a result of NAC alone (before any surgical resection) and 6 had suboptimal disease. All were considered optimally debulked at the end of surgery. Three subjects had no residual tumor in the pathologic specimen. The mean hospital stay was 4.85 days (range 3–6). Two subjects underwent bowel resection, 2 had an ICU stay, and 8 received a blood transfusion. 18/20 subjects received 6 cycles of IP/IV chemotherapy. One subject had disease progression and another could not tolerate IP/IV after 3 cycles and received the final 3 cycles IV. 18/20 subjects experienced at least gr.1 neuropathy. Conclusion. NAC followed by debulking surgery and IP/IV chemotherapy is feasible in women with advanced ovarian cancer. Women receiving NAC appear to be very tolerant of IP/ IV chemotherapy, with a high rate of completion of 6 cycles. Consistent with previous reports of NAC, morbidity associated with surgery appears to be decreased, which may contribute to the high rate of IP/IV completion. doi:10.1016/j.ygyno.2007.08.024

15 Multi-Institutional Retrospective Analysis of Lymphadenectomy in Early Stage Adenocarcinoma of the Cervix M.P. Schlumbrecht, L.M. Knowles, D.S. Miller, J.O. Schorge The University of Texas-Southwestern Medical Center, Dallas, TX Objective. Recent studies reviewing the extent of lymph node dissection in the surgical management of endometrial adenocarcinoma suggest improvement in outcome with increasing nodal count. Radical hysterectomy with lymphadenectomy is the accepted surgical treatment for early stage adenocarcinoma of the cervix. The purpose of this study was to evaluate the extent of lymphadenectomy and its effect on progressionfree survival (PFS) and overall survival (OS) in patients with early stage adenocarcinoma of the cervix treated surgically. Methods. Patients who underwent radical hysterectomy and lymphadenectomy (LAD) for early stage adenocarcinoma of the cervix between 1982 and 2006 from three institutions were identified. Charts were reviewed and data extracted, including demographic information, stage, histology, grade, surgical procedure, lymph node count, nodal status, and outcome. Mean PFS and OS were calculated. Statistical analysis was performed using the Student's t-test and Chi square analysis. Results. Two hundred twelve patients with early stage adenocarcinoma who underwent surgical management were identified. Thirty patients underwent both pelvic and para-aortic LAD; 176 had pelvic LAD alone. The average number of lymph nodes dissected was 17.32; median pelvic node count was 15.