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M325 EVALUATION OF INTERVAL DEBULKING SURGERY IN ADVANCED EPITHELIAL OVARIAN CANCER AND DISCUSSION OF INDICATIONS
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Conclusions: The primary treatment of early-stage cervical carcinoma involves either surgery or radiation therapy, with or without chemotherapy. Surgery is reserved for lower-stage disease and smaller lesions in surgically fit and young patients. The immediate postoperative outcome is good for carefully selected cases. M323 CHALLENGES AND OPPORTUNITIES IN PALLIATIVE CARE IN NEPAL G. Dangal1 . 1 OB/GYN, Kathamndu Model Hospital, Kathmandu, Nepal Objectives: Majority of cancer patients in Nepal are diagnosed in advanced stage but palliative care is not available in most part of the country. Pain is the most common symptom in patients with advanced cancer and is usually undertreated. Barriers to palliative care and pain management in Nepal are physicianpractice behaviors, patient-related barriers, policy-related barriers, etc. In this article, the opportunities and the challenges faced in promoting/setting up palliative care practice in Nepal are examined. Materials: This is a review of existing palliative care services, policies and activities in Nepal. Information and data regarding terminal illness, cancers and palliative care were collected from different institutions and palliative care providers across the country. Methods: Literature search was also done for secondary data. Some of the information presented in this is from the personal observations and interviews of care providers, pioneers and policy makers of the country. Review of curricula of the medical undergraduate and postgraduate courses of Nepalese medical schools for palliative care courses was also done. Results: Seventy percent of cancer patients in Nepal come at the late stage. There is a trend of late presentation and thus late diagnosis because of the use of traditional remedies and alternative medicine. This study showed that the palliative care facility in Nepal is limited and grossly inadequate with few institutions providing palliative care in the capital city and none in small towns. Opiods use and availability is limited to big cities only and is underprescribed due to fear of misuse, lack of awareness, shortage of resources and legal regulations. Being a new specialty, palliative care is yet to be incorporated in the existing national health system and there is no national policy on palliative care. It is not included in the medical curricula of Nepalese medical schools. However, informal trainings and advocacy are going on. Conclusions: Palliative care is a need in Nepal. All should have access to care during a serious illness and at the end of life. In order to expand and upgrade palliative care nation-wide, integration of it in the existing health care system should receive a priority. It needs combined efforts to establish state of art palliative care in the country by formulating national policy, incorporating it in the medical curricula and raising awareness. M324 SURGICO-PATHOLOGICAL SPREAD PATTERNS OF ENDOMETRIAL CANCER IN WOMEN WHO UNDERWENT SURGERY IN AMPANG HOSPITAL MALAYSIA: A RETROSPECTIVE REVIEW S. Nambiar1 , L. Sivapatham1 , C.M. Yong1 , J. Omar1 , M. Ganesalingam1 . 1 Obstetrics and Gynaecology, Hospital Ampang, Kuala Lumpur, Wilayah Persekutuan, Malaysia Objectives: Endometrial cancer is the second most common gynaecological cancer in Malaysia. Hysterectomy and bilateral salpingo oophorectomy is the standard accepted surgery for early stage disease The role of systematic pelvic lymphadenectomy remains controversial due to its complications. The aim of our study was to look at lymph node and lymphovascular space involvement
S635
and its association with myoinvasion in those who underwent surgery. Materials: 38 women with endometrial carcinoma underwent primary surgery in the Department of Obstetrics and Gynaecology, Ampang Hospital, Malaysia between August 2009 and Sept 2011. Methods: Data was obtained from patient files and pathology reports. Exclusions included women who did not have lymphadenectomy, inoperable tumours and histology other than endometrioid adenocarcinoma. All surgeries were performed by the same surgeon and surgical staging included a total abdominal hysterectomy, bilateral salpinogoophorectomy and bilateral pelvic lymphadenectomy with or without paraaortic lymph node dissection. Results: The mean age of the women was 55.5±11.21 years (range 33–75). Distribution of tumour grade was as follows; grade 1, 8 (21.6%); grade 2, 19 (51%); grade 3, 10 (27%). 32% had lymphovascular space invasion. 27% and 15% had pelvc and paraaortic involvement respectively. 6% had para aortic LN involvement with negative pelvic nodes. There is an increasing trend of lymph node involvement with higher grade of disease. Only 1 (2%) woman with a Grade 1 tumour had lymph node involvement. Among those with Grade 2 and 3 tumours, 21% and 30% had LN involvement respectively. 59% had >50% myoinvasion and out of these, 45% had lymphovascular space invasion. The incidence of lymph node metastasis in relation to myoinvasion and grade of tumour was as follows; when there was <50% myoinvasion, 20% had lymph node involvement. With >50% myoinvasion, 26% had lymph node involvement. In 4 cases, there was lymph node involvement but no lymphovascular space invasion. The mean number of lymph nodes extirpated was 28.5±9.46 with the minimum of 13 and a maximum of 57 nodes. Complication rates were low. All women were discharged within 7 days of surgery. Only 2 out of the 38 women presented later with lymphocysts. Conclusions: Grade of tumour and myoinvasion predicts lymph nodes involvement. The incidence of paraaortic lymph nodes involvement cannot be overlooked. A further trial is needed to address the criteria needed to perform paraaortic lymph node dissection. M325 EVALUATION OF INTERVAL DEBULKING SURGERY IN ADVANCED EPITHELIAL OVARIAN CANCER AND DISCUSSION OF INDICATIONS H. Cui1 . 1 Peking University People’s Hospital, Beijing, China Objectives: The precise significance of IDS need to be evaluated. Also, to study and discuss indications of IDS. Materials: 136 consecutive patients with stage IIIc or IV EOC or PPC or PTC who completed primary debulking surgery and platinumbased chemotherapy were enrolled from 2000.1 to 2009.12 in a retrospective cohort study. Methods: The study group was divided into three groups: 65 cases had optimal PDS (Group A), 41 patients received chemotherapy alone after suboptimal PDS (B), 30 patients received IDS after suboptimal PDS (C). All patients received 6–8 courses of platinumbased combination chemotherapy. Indications of IDS are to be discussed by comparing all patients’ clinical characteristics, perioperative situation and prognosis. It is also necessary to check the CA125 level and B ultrasound both before and after IDS in group C, then compare them with pathological consequence. Results: 47.8% of the 136 patients had achieved optimal PDS. For group C, 76.7% (23/30) patients had obtained optimal debulking surgery after IDS. Intraoperative injury rates were similar between Group B and C. Mild perioperative complications rate was similar, too. Median OS of Group B and C were 31 months and 40 months respectively (P = 0.254). Median PFS of Group B and Group C were 13 months and 26 months respectively (P = 0.289). Although when it came to 20 months after PDS, patients who underwent IDS had
S636
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
a significantly lower PD rate (Group B, 33.3% vs. Group C 60.9%, P = 0.046), it still showed that there was no significant difference in either OS or PFS of these two groups. Those patients in Group C who obtained no visible residual got similar PFS comparing to Group A (p = 0.730), although OS is still shorter. 23 patients (76.7%, 23/30) from group C had gone through optimal debulking, among which there are 11 who got a negative pathological result. The sensitivity of both CA125 level and B ultrasound before IDS were poor, while the specificity of CA125 level could reach to 100%. The accuracy of CA125 combined with B ultrasound to predict pathological consequence was 70%. Conclusions: IDS has little effect in improving survival of advanced EOC patients. However, it is safe and acceptable, also may prolong PFS in those patients who got no visible residual after IDS. The major indications of IDS are concluded as follows: (1) basic dubulking in PDS; (2) partial remission after 3 courses of chemotherapy with abnormal CA125 level; (3) normal CA125 with positive consequence in PET-CT/E-CT; (4) residual lesion could be removed in further IDS. M326 ADENOGENOUS CARCINOMA IN SITU OF THE CERVIX AND DIAGNOSTIC PROBLEMS A.A. Sidoruk1 , V.I. Novik2 , A.F. Urmancheeva1,2 . 1 Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation; 2 N.N. Petrov Research Institute of Oncology, Saint Petersburg, Russian Federation Objectives: This study purposed to assess clinico-morphological features of adenogenous carcinoma in situ of the cervix. Materials: All cases of adenogenous carcinoma in situ of the cervix (n = 57) which were diagnosed in N.N. Petrov Research Institute of Oncology during 1970–2005 were the following: 30 cases were undifferentiated (reserve cell) carcinoma in situ, 27 – adenocarcinoma in situ. Methods: Thirty two cytological specimens restained after Feulgen were analyzed with DNA image cytometry. Results: The average age of patients was 46.0±2.3 years (range 23–69 years). Clinical features were asymptomatic or non-specific. Smears of all patients revealed tumor cells at cytological examination. Accuracy of expected definition of a hystotype for reserve cell carcinoma in situ was 83%, predictable meaning of the cytological examination was 68%. The corresponding indicators for adenocarcinoma in situ were 52% and 58%. The informative biopsy specimens were in 54% for reserve cell carcinoma in situ and in 32% for adenocarcinoma in situ cases. Histological examination of postsurgical material was the most important method in accurate definition of adenogenous carcinoma in situ. However, in our study histological examination did not detect malignant tumor in 16% of all cases (5 cases of reserve cell carcinoma in situ and 4 cases of adenocarcinoma in situ), which was verified with DNA image cytometry at Feulgen restained cytological smears. Conclusions: A rarely met type of cancer with difficult diagnostic features is adenogenous carcinoma in situ of the cervix. DNA image cytometry represents a highly relevant method in the identification of malignant transformation in endocervical lesions in morphological difficult cases. M327 INVASIVE CERVICAL CANCER AND PREGNANCY A.A. Sidoruk1 , A.F. Urmancheeva1,2 . 1 Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation; 2 N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Russian Federation Objectives: Cervical cancer ranks first among the tumors associated with pregnancy, its frequency is from 1 to 13 cases per 10,000 pregnancies. We studied the clinical features of pregnant patients with invasive cervical cancer.
Materials: This study analyzes the clinical data of 8 pregnant patients with invasive cervical cancer (pregnancy, I trimester: IB st-5 cases, IIA st-3 cases) treated in N.N. Petrov Research Institute of Oncology during 2006–2009. Methods: The clinical data comparison was conducted with the group of 20 observations of cervical invasive carcinoma (IB and IIA st-10 women, respectively). Results: The average age of pregnant patients with invasive cervical cancer 32±2.35 years, while the average age of patients with cervical carcinoma 45.6±1.15 years [p < 0.05]. The common symptom is bleeding (50%-pregnant women, 55%-nonpregnant). Latent disease ran in 25% of cases (2/8) in pregnant patients and 15% (3/20) in the control group of patients without pregnancies. In the remaining cases there were such symptoms as leucorrhea and pain: in 25% of patients with cancer of the cervix during pregnancy and in 30% in comparison group [p > 0.05]. All patients had their operations – radical hysterectomy with pelvic lymphadenectomy (removal of the uterus of pregnant patients with fetus in situ). Metastases to regional lymph nodes of the pelvis according to the morphological study of operational material were found in 3 (37.5%) pregnant patients with cervical cancer, which was 2 more than in the control group (20%, 4/20), [p < 0.05]. In this connection, these 7 patients were classified as stage III disease (metastatic variant). Postoperatively, adjuvant radiation therapy was performed in patients with stage III disease with combination chemotherapy. Monitoring after treatment ranged from 3 to 5 years. Four patients (50%) revealed local recurrences after treatment out of the 8 pregnant patients with invasive cervical cancer. In the control group of non-pregnant patients recurrent disease was observed in 40% of cases (8/20), [p > 0.05]. Conclusions: Pregnant patients with invasive cervical cancer are 13.5 years younger than the patients with invasive carcinoma of the cervix. Symptoms, clinical presentation of invasive cervical cancer during pregnancy does not differ substantially from the tumors in nonpregnant women. Lymphogenous metastases of cervical cancer in pregnant women are high. Comparison of the 5-year survival rate of the pregnant patients with cervical cancer showed no differences from nonpregnant ones. M328 THE EFFICACY AND SAFETY OF NEOADJUVANT CHEMOTHERAPY IN THE TREATMENT OF LOCALLY ADVANCED CANCER CERVIX U. Singh1 , N. Ahirwar1 , Nisha1 , K. Srivastava1 , P. Sankhwar1 , S. Qureshi1 . 1 CSMMedical University, Lucknow, UP, India Objectives: Developing countries face the problem of significant number of cases of cancer cervix being diagnosed in advanced stage. Chemoradiation, the standard treatment, at present, has limitations both in efficacy and availability. Neo adjuvant chemotherapy can be a useful modality in such a scenario. This study was planned to assess the efficacy and safety of neoadjuvant chemotherapy in treatment of locally advanced carcinoma cervix. Materials: 26 patients admitted in the department of Obstetrics and Gynaecology, CSM Medical University, Lucknow, India with histopathologically proven carcinoma cervix of stage 2 and 3 were included in the study. Methods: Cisplatin 75 mg/m2 and paclitaxel 135 mg/m2 were given at 14 days interval with routine monitoring for a maximum of three courses. Clinical assessment for down staging and operability status was done followed by radical surgery or radiotherapy. Results: Down staging was seen in 70% of cases, 50% became operable. Significant response in tumor size was observed – complete response in 50%, partial response in 38.4%. Side effects were alopecia (100%), anorexia (60.7%), nausea (60.7%), anaemia (23%). Conclusions: Neoadjuvant chemotherapy is a safe and effective method of down staging the locally advanced disease. Radical surgery can be offered to some of these cases.
Conclusions: The primary treatment of early-stage cervical carcinoma involves either surgery or radiation therapy, with or without chemotherapy. Surgery is reserved for lower-stage disease and smaller lesions in surgically fit and young patients. The immediate postoperative outcome is good for carefully selected cases. M323 CHALLENGES AND OPPORTUNITIES IN PALLIATIVE CARE IN NEPAL G. Dangal1 . 1 OB/GYN, Kathamndu Model Hospital, Kathmandu, Nepal Objectives: Majority of cancer patients in Nepal are diagnosed in advanced stage but palliative care is not available in most part of the country. Pain is the most common symptom in patients with advanced cancer and is usually undertreated. Barriers to palliative care and pain management in Nepal are physicianpractice behaviors, patient-related barriers, policy-related barriers, etc. In this article, the opportunities and the challenges faced in promoting/setting up palliative care practice in Nepal are examined. Materials: This is a review of existing palliative care services, policies and activities in Nepal. Information and data regarding terminal illness, cancers and palliative care were collected from different institutions and palliative care providers across the country. Methods: Literature search was also done for secondary data. Some of the information presented in this is from the personal observations and interviews of care providers, pioneers and policy makers of the country. Review of curricula of the medical undergraduate and postgraduate courses of Nepalese medical schools for palliative care courses was also done. Results: Seventy percent of cancer patients in Nepal come at the late stage. There is a trend of late presentation and thus late diagnosis because of the use of traditional remedies and alternative medicine. This study showed that the palliative care facility in Nepal is limited and grossly inadequate with few institutions providing palliative care in the capital city and none in small towns. Opiods use and availability is limited to big cities only and is underprescribed due to fear of misuse, lack of awareness, shortage of resources and legal regulations. Being a new specialty, palliative care is yet to be incorporated in the existing national health system and there is no national policy on palliative care. It is not included in the medical curricula of Nepalese medical schools. However, informal trainings and advocacy are going on. Conclusions: Palliative care is a need in Nepal. All should have access to care during a serious illness and at the end of life. In order to expand and upgrade palliative care nation-wide, integration of it in the existing health care system should receive a priority. It needs combined efforts to establish state of art palliative care in the country by formulating national policy, incorporating it in the medical curricula and raising awareness. M324 SURGICO-PATHOLOGICAL SPREAD PATTERNS OF ENDOMETRIAL CANCER IN WOMEN WHO UNDERWENT SURGERY IN AMPANG HOSPITAL MALAYSIA: A RETROSPECTIVE REVIEW S. Nambiar1 , L. Sivapatham1 , C.M. Yong1 , J. Omar1 , M. Ganesalingam1 . 1 Obstetrics and Gynaecology, Hospital Ampang, Kuala Lumpur, Wilayah Persekutuan, Malaysia Objectives: Endometrial cancer is the second most common gynaecological cancer in Malaysia. Hysterectomy and bilateral salpingo oophorectomy is the standard accepted surgery for early stage disease The role of systematic pelvic lymphadenectomy remains controversial due to its complications. The aim of our study was to look at lymph node and lymphovascular space involvement
S635
and its association with myoinvasion in those who underwent surgery. Materials: 38 women with endometrial carcinoma underwent primary surgery in the Department of Obstetrics and Gynaecology, Ampang Hospital, Malaysia between August 2009 and Sept 2011. Methods: Data was obtained from patient files and pathology reports. Exclusions included women who did not have lymphadenectomy, inoperable tumours and histology other than endometrioid adenocarcinoma. All surgeries were performed by the same surgeon and surgical staging included a total abdominal hysterectomy, bilateral salpinogoophorectomy and bilateral pelvic lymphadenectomy with or without paraaortic lymph node dissection. Results: The mean age of the women was 55.5±11.21 years (range 33–75). Distribution of tumour grade was as follows; grade 1, 8 (21.6%); grade 2, 19 (51%); grade 3, 10 (27%). 32% had lymphovascular space invasion. 27% and 15% had pelvc and paraaortic involvement respectively. 6% had para aortic LN involvement with negative pelvic nodes. There is an increasing trend of lymph node involvement with higher grade of disease. Only 1 (2%) woman with a Grade 1 tumour had lymph node involvement. Among those with Grade 2 and 3 tumours, 21% and 30% had LN involvement respectively. 59% had >50% myoinvasion and out of these, 45% had lymphovascular space invasion. The incidence of lymph node metastasis in relation to myoinvasion and grade of tumour was as follows; when there was <50% myoinvasion, 20% had lymph node involvement. With >50% myoinvasion, 26% had lymph node involvement. In 4 cases, there was lymph node involvement but no lymphovascular space invasion. The mean number of lymph nodes extirpated was 28.5±9.46 with the minimum of 13 and a maximum of 57 nodes. Complication rates were low. All women were discharged within 7 days of surgery. Only 2 out of the 38 women presented later with lymphocysts. Conclusions: Grade of tumour and myoinvasion predicts lymph nodes involvement. The incidence of paraaortic lymph nodes involvement cannot be overlooked. A further trial is needed to address the criteria needed to perform paraaortic lymph node dissection. M325 EVALUATION OF INTERVAL DEBULKING SURGERY IN ADVANCED EPITHELIAL OVARIAN CANCER AND DISCUSSION OF INDICATIONS H. Cui1 . 1 Peking University People’s Hospital, Beijing, China Objectives: The precise significance of IDS need to be evaluated. Also, to study and discuss indications of IDS. Materials: 136 consecutive patients with stage IIIc or IV EOC or PPC or PTC who completed primary debulking surgery and platinumbased chemotherapy were enrolled from 2000.1 to 2009.12 in a retrospective cohort study. Methods: The study group was divided into three groups: 65 cases had optimal PDS (Group A), 41 patients received chemotherapy alone after suboptimal PDS (B), 30 patients received IDS after suboptimal PDS (C). All patients received 6–8 courses of platinumbased combination chemotherapy. Indications of IDS are to be discussed by comparing all patients’ clinical characteristics, perioperative situation and prognosis. It is also necessary to check the CA125 level and B ultrasound both before and after IDS in group C, then compare them with pathological consequence. Results: 47.8% of the 136 patients had achieved optimal PDS. For group C, 76.7% (23/30) patients had obtained optimal debulking surgery after IDS. Intraoperative injury rates were similar between Group B and C. Mild perioperative complications rate was similar, too. Median OS of Group B and C were 31 months and 40 months respectively (P = 0.254). Median PFS of Group B and Group C were 13 months and 26 months respectively (P = 0.289). Although when it came to 20 months after PDS, patients who underwent IDS had
S636
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
a significantly lower PD rate (Group B, 33.3% vs. Group C 60.9%, P = 0.046), it still showed that there was no significant difference in either OS or PFS of these two groups. Those patients in Group C who obtained no visible residual got similar PFS comparing to Group A (p = 0.730), although OS is still shorter. 23 patients (76.7%, 23/30) from group C had gone through optimal debulking, among which there are 11 who got a negative pathological result. The sensitivity of both CA125 level and B ultrasound before IDS were poor, while the specificity of CA125 level could reach to 100%. The accuracy of CA125 combined with B ultrasound to predict pathological consequence was 70%. Conclusions: IDS has little effect in improving survival of advanced EOC patients. However, it is safe and acceptable, also may prolong PFS in those patients who got no visible residual after IDS. The major indications of IDS are concluded as follows: (1) basic dubulking in PDS; (2) partial remission after 3 courses of chemotherapy with abnormal CA125 level; (3) normal CA125 with positive consequence in PET-CT/E-CT; (4) residual lesion could be removed in further IDS. M326 ADENOGENOUS CARCINOMA IN SITU OF THE CERVIX AND DIAGNOSTIC PROBLEMS A.A. Sidoruk1 , V.I. Novik2 , A.F. Urmancheeva1,2 . 1 Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation; 2 N.N. Petrov Research Institute of Oncology, Saint Petersburg, Russian Federation Objectives: This study purposed to assess clinico-morphological features of adenogenous carcinoma in situ of the cervix. Materials: All cases of adenogenous carcinoma in situ of the cervix (n = 57) which were diagnosed in N.N. Petrov Research Institute of Oncology during 1970–2005 were the following: 30 cases were undifferentiated (reserve cell) carcinoma in situ, 27 – adenocarcinoma in situ. Methods: Thirty two cytological specimens restained after Feulgen were analyzed with DNA image cytometry. Results: The average age of patients was 46.0±2.3 years (range 23–69 years). Clinical features were asymptomatic or non-specific. Smears of all patients revealed tumor cells at cytological examination. Accuracy of expected definition of a hystotype for reserve cell carcinoma in situ was 83%, predictable meaning of the cytological examination was 68%. The corresponding indicators for adenocarcinoma in situ were 52% and 58%. The informative biopsy specimens were in 54% for reserve cell carcinoma in situ and in 32% for adenocarcinoma in situ cases. Histological examination of postsurgical material was the most important method in accurate definition of adenogenous carcinoma in situ. However, in our study histological examination did not detect malignant tumor in 16% of all cases (5 cases of reserve cell carcinoma in situ and 4 cases of adenocarcinoma in situ), which was verified with DNA image cytometry at Feulgen restained cytological smears. Conclusions: A rarely met type of cancer with difficult diagnostic features is adenogenous carcinoma in situ of the cervix. DNA image cytometry represents a highly relevant method in the identification of malignant transformation in endocervical lesions in morphological difficult cases. M327 INVASIVE CERVICAL CANCER AND PREGNANCY A.A. Sidoruk1 , A.F. Urmancheeva1,2 . 1 Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation; 2 N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Russian Federation Objectives: Cervical cancer ranks first among the tumors associated with pregnancy, its frequency is from 1 to 13 cases per 10,000 pregnancies. We studied the clinical features of pregnant patients with invasive cervical cancer.
Materials: This study analyzes the clinical data of 8 pregnant patients with invasive cervical cancer (pregnancy, I trimester: IB st-5 cases, IIA st-3 cases) treated in N.N. Petrov Research Institute of Oncology during 2006–2009. Methods: The clinical data comparison was conducted with the group of 20 observations of cervical invasive carcinoma (IB and IIA st-10 women, respectively). Results: The average age of pregnant patients with invasive cervical cancer 32±2.35 years, while the average age of patients with cervical carcinoma 45.6±1.15 years [p < 0.05]. The common symptom is bleeding (50%-pregnant women, 55%-nonpregnant). Latent disease ran in 25% of cases (2/8) in pregnant patients and 15% (3/20) in the control group of patients without pregnancies. In the remaining cases there were such symptoms as leucorrhea and pain: in 25% of patients with cancer of the cervix during pregnancy and in 30% in comparison group [p > 0.05]. All patients had their operations – radical hysterectomy with pelvic lymphadenectomy (removal of the uterus of pregnant patients with fetus in situ). Metastases to regional lymph nodes of the pelvis according to the morphological study of operational material were found in 3 (37.5%) pregnant patients with cervical cancer, which was 2 more than in the control group (20%, 4/20), [p < 0.05]. In this connection, these 7 patients were classified as stage III disease (metastatic variant). Postoperatively, adjuvant radiation therapy was performed in patients with stage III disease with combination chemotherapy. Monitoring after treatment ranged from 3 to 5 years. Four patients (50%) revealed local recurrences after treatment out of the 8 pregnant patients with invasive cervical cancer. In the control group of non-pregnant patients recurrent disease was observed in 40% of cases (8/20), [p > 0.05]. Conclusions: Pregnant patients with invasive cervical cancer are 13.5 years younger than the patients with invasive carcinoma of the cervix. Symptoms, clinical presentation of invasive cervical cancer during pregnancy does not differ substantially from the tumors in nonpregnant women. Lymphogenous metastases of cervical cancer in pregnant women are high. Comparison of the 5-year survival rate of the pregnant patients with cervical cancer showed no differences from nonpregnant ones. M328 THE EFFICACY AND SAFETY OF NEOADJUVANT CHEMOTHERAPY IN THE TREATMENT OF LOCALLY ADVANCED CANCER CERVIX U. Singh1 , N. Ahirwar1 , Nisha1 , K. Srivastava1 , P. Sankhwar1 , S. Qureshi1 . 1 CSMMedical University, Lucknow, UP, India Objectives: Developing countries face the problem of significant number of cases of cancer cervix being diagnosed in advanced stage. Chemoradiation, the standard treatment, at present, has limitations both in efficacy and availability. Neo adjuvant chemotherapy can be a useful modality in such a scenario. This study was planned to assess the efficacy and safety of neoadjuvant chemotherapy in treatment of locally advanced carcinoma cervix. Materials: 26 patients admitted in the department of Obstetrics and Gynaecology, CSM Medical University, Lucknow, India with histopathologically proven carcinoma cervix of stage 2 and 3 were included in the study. Methods: Cisplatin 75 mg/m2 and paclitaxel 135 mg/m2 were given at 14 days interval with routine monitoring for a maximum of three courses. Clinical assessment for down staging and operability status was done followed by radical surgery or radiotherapy. Results: Down staging was seen in 70% of cases, 50% became operable. Significant response in tumor size was observed – complete response in 50%, partial response in 38.4%. Side effects were alopecia (100%), anorexia (60.7%), nausea (60.7%), anaemia (23%). Conclusions: Neoadjuvant chemotherapy is a safe and effective method of down staging the locally advanced disease. Radical surgery can be offered to some of these cases.