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Obesity and a Higher Body Mass Index (BMI) May be Protective among Women Treated for Cervical Cancer
I. J. Radiation Oncology d Biology d Physics
S418
Volume 78, Number 3, Supplement, 2010
Conclusions: Multimodality adjuvant therapy improves RFS in surgically staged UC patients compared to single modality adjuvant therapy. Author Disclosure: Y. Hasan, None; L. Tait, None; M. Hasselle, None; A. Meriwether, None; K. Wroblewski, None; L. Herman, None; D. Yamada, None.
2480
Obesity and a Higher Body Mass Index (BMI) May be Protective among Women Treated for Cervical Cancer
M. R. Kudrimoti, J. Feddock, M. Randall, L. Baldwin, L. Seamon, C. DeSimone University of Kentucky Medical Center, Lexington, KY Purpose/Objective(s): Obesity has been associated with inferior outcomes in several different malignancies, most notably endometrial cancer. A similar trend has not been well documented among women diagnosed with cervical cancer, although several recent series have documented lower rates of cervical cancer screening in women considered overweight or obese. A retrospective chart review was performed in an effort to evaluate the impact of obesity on treatment outcomes in women with cervical. Materials/Methods: The records of 487 patients treated for cervical cancer at the University of Kentucky, between December 1988 and March 2009, were compiled and analyzed for outcomes of therapy. Patients were identified based on billing codes for medical services provided including radical hysterectomy, inpatient chemotherapy, low dose rate, and high dose rate brachytherapy procedures. Results: Patients accrued have a median age of 44. Stages are distributed as follows: stage I: n = 216, II: n = 173, III: n = 75, and IV: n = 23. Body mass index (BMI) categories include Anorexic (BMI \ 18.5): n = 20, Normal BMI (18.5-24.9): n =164, Overweight (BMI, 25-29.9): n = 139, Obese (BMI 30-40): n = 131, and Morbidly Obese (BMI .40): n =33. Patients were not significantly different with respect to major prognostic factors including histologic subtype and grade, overall stage at diagnosis, incidence of treatment breaks, total treatment duration, and incidence of grade 2 or higher treatment related toxicity. Patients with a BMI \ 18.5 had significantly higher rates of smoking (p = 0.003), and had a lower incidence of major medical comorbidities. After a median follow-up time of 49 months, there was a trend for worse 5 yr Disease Free Survival (DFS) among anorexic and morbidly obese patients, with rates of 60%, 79.3%, 75.5%, 81.7%, and 69.7% for patients with a BMI \18.5, 18.5-24.9, 25-29.9, 30-40, and .40, respectively. (p = 0.123) A significantly worse 5 yr overall survival (OS) rate (35%) was seen among anorexic patients compared to 73.2%, 66.2%, 74%, and 66.7% for the remaining BMI groups, respectively (p = 0.01). Conclusions: Anorexia appears to be a significant marker for adverse outcomes independent of other well-established prognostic variables. In our study population, women who were overweight or obese demonstrated improved survival measures, supporting a protective effect of a high BMI for women undergoing treatment for early stage and advanced cervical cancer. Author Disclosure: M.R. Kudrimoti, None; J. Feddock, None; M. Randall, None; L. Baldwin, None; L. Seamon, None; C. DeSimone, None.
2481
Nodal State Determines Outcome in Vulvar Cancer
A. Mohr, S. Rieken, H. Hof, M. Bischof, S. E. Combs, J. Debus, K. Lindel University Hospital of Heidelberg, Heidelberg, Germany Purpose / Objective(s): Aim of the study was to determine outcome of patients with advanced vulvar cancer receiving radiotherapy and to evaluate prognostic factors for treatment outcome. Materials/Methods: From 1996 to 2010, 94 patients with pathologically confirmed vulvar cancer were treated at the Department of Radiation Oncology at the University Hospital of Heidelberg. 51 patients received radiotherapy during their first-line treatment. 43 patients received radiation therapy for recurrent vulvar carcinoma. Statistical analyses were performed using the Kaplan-Meier method, log-rank and Fischer-Exact-Test (SSPS15.0). Results: Median follow-up was 34 months. Overall survival was 85%, 75%, and 55% after 1, 3, and 5 years. Of all patients 46.8% presented with inguinal lymph node metastases at initial diagnosis. Of these, 77% were irradiated postoperatively, while 23% underwent irradiation only after relapse of disease. Overall survival was reduced significantly in case of primary inguinal lymph node metastases (p = 0.001). T state, grading, extent of initial surgery, and additional chemotherapy did not significantly influence treatment outcome. Patients radiated with a total dose . 50 Gy either local or regional had a better overall survival (p=0.065). In case of radiotherapy for patients with recurrent carcinoma, overall survival was significantly lower for patients, who had been diagnosed with lymphatic spread at initial diagnosis (p = 0.01). Conclusions: Inguinal lymph node metastases were the only significant prognostic factor for overall survival in vulvar cancer patients. For adjuvant radiation a total dose of more than 50 Gy is recommended. Author Disclosure: A. Mohr, None; S. Rieken, None; H. Hof, None; M. Bischof, None; S.E. Combs, None; J. Debus, None; K. Lindel, None.
2482
Postoperative Concomitant Cisplatin-based Chemoradiation in Patients with Endometrial Carcinoma at High Risk for Recurrence
M. E. Olsheski1, G. Salame1, O. Abulafia1, M. Rotman1, Y. Lee1, P. Han1, M. Schwartz1,2, W. Choi3, C. Gasson4, K. Choi1 SUNY Downstate Medical Center, Brooklyn, NY, 2Kings County Hospital Center, Brooklyn, NY, 3Beth Israel Medical Center, Manhattan, NY, 4Albany Radiation Oncology Associates, LLC, Albany, NY 1
Purpose/Objective(s): Primary treatment of endometrial cancer is surgical, but adjuvant radiation therapy (RT) and chemotherapy (CT) have been shown to decrease the incidence of locoregional recurrences. Despite current treatments including postoperative
S418
Volume 78, Number 3, Supplement, 2010
Conclusions: Multimodality adjuvant therapy improves RFS in surgically staged UC patients compared to single modality adjuvant therapy. Author Disclosure: Y. Hasan, None; L. Tait, None; M. Hasselle, None; A. Meriwether, None; K. Wroblewski, None; L. Herman, None; D. Yamada, None.
2480
Obesity and a Higher Body Mass Index (BMI) May be Protective among Women Treated for Cervical Cancer
M. R. Kudrimoti, J. Feddock, M. Randall, L. Baldwin, L. Seamon, C. DeSimone University of Kentucky Medical Center, Lexington, KY Purpose/Objective(s): Obesity has been associated with inferior outcomes in several different malignancies, most notably endometrial cancer. A similar trend has not been well documented among women diagnosed with cervical cancer, although several recent series have documented lower rates of cervical cancer screening in women considered overweight or obese. A retrospective chart review was performed in an effort to evaluate the impact of obesity on treatment outcomes in women with cervical. Materials/Methods: The records of 487 patients treated for cervical cancer at the University of Kentucky, between December 1988 and March 2009, were compiled and analyzed for outcomes of therapy. Patients were identified based on billing codes for medical services provided including radical hysterectomy, inpatient chemotherapy, low dose rate, and high dose rate brachytherapy procedures. Results: Patients accrued have a median age of 44. Stages are distributed as follows: stage I: n = 216, II: n = 173, III: n = 75, and IV: n = 23. Body mass index (BMI) categories include Anorexic (BMI \ 18.5): n = 20, Normal BMI (18.5-24.9): n =164, Overweight (BMI, 25-29.9): n = 139, Obese (BMI 30-40): n = 131, and Morbidly Obese (BMI .40): n =33. Patients were not significantly different with respect to major prognostic factors including histologic subtype and grade, overall stage at diagnosis, incidence of treatment breaks, total treatment duration, and incidence of grade 2 or higher treatment related toxicity. Patients with a BMI \ 18.5 had significantly higher rates of smoking (p = 0.003), and had a lower incidence of major medical comorbidities. After a median follow-up time of 49 months, there was a trend for worse 5 yr Disease Free Survival (DFS) among anorexic and morbidly obese patients, with rates of 60%, 79.3%, 75.5%, 81.7%, and 69.7% for patients with a BMI \18.5, 18.5-24.9, 25-29.9, 30-40, and .40, respectively. (p = 0.123) A significantly worse 5 yr overall survival (OS) rate (35%) was seen among anorexic patients compared to 73.2%, 66.2%, 74%, and 66.7% for the remaining BMI groups, respectively (p = 0.01). Conclusions: Anorexia appears to be a significant marker for adverse outcomes independent of other well-established prognostic variables. In our study population, women who were overweight or obese demonstrated improved survival measures, supporting a protective effect of a high BMI for women undergoing treatment for early stage and advanced cervical cancer. Author Disclosure: M.R. Kudrimoti, None; J. Feddock, None; M. Randall, None; L. Baldwin, None; L. Seamon, None; C. DeSimone, None.
2481
Nodal State Determines Outcome in Vulvar Cancer
A. Mohr, S. Rieken, H. Hof, M. Bischof, S. E. Combs, J. Debus, K. Lindel University Hospital of Heidelberg, Heidelberg, Germany Purpose / Objective(s): Aim of the study was to determine outcome of patients with advanced vulvar cancer receiving radiotherapy and to evaluate prognostic factors for treatment outcome. Materials/Methods: From 1996 to 2010, 94 patients with pathologically confirmed vulvar cancer were treated at the Department of Radiation Oncology at the University Hospital of Heidelberg. 51 patients received radiotherapy during their first-line treatment. 43 patients received radiation therapy for recurrent vulvar carcinoma. Statistical analyses were performed using the Kaplan-Meier method, log-rank and Fischer-Exact-Test (SSPS15.0). Results: Median follow-up was 34 months. Overall survival was 85%, 75%, and 55% after 1, 3, and 5 years. Of all patients 46.8% presented with inguinal lymph node metastases at initial diagnosis. Of these, 77% were irradiated postoperatively, while 23% underwent irradiation only after relapse of disease. Overall survival was reduced significantly in case of primary inguinal lymph node metastases (p = 0.001). T state, grading, extent of initial surgery, and additional chemotherapy did not significantly influence treatment outcome. Patients radiated with a total dose . 50 Gy either local or regional had a better overall survival (p=0.065). In case of radiotherapy for patients with recurrent carcinoma, overall survival was significantly lower for patients, who had been diagnosed with lymphatic spread at initial diagnosis (p = 0.01). Conclusions: Inguinal lymph node metastases were the only significant prognostic factor for overall survival in vulvar cancer patients. For adjuvant radiation a total dose of more than 50 Gy is recommended. Author Disclosure: A. Mohr, None; S. Rieken, None; H. Hof, None; M. Bischof, None; S.E. Combs, None; J. Debus, None; K. Lindel, None.
2482
Postoperative Concomitant Cisplatin-based Chemoradiation in Patients with Endometrial Carcinoma at High Risk for Recurrence
M. E. Olsheski1, G. Salame1, O. Abulafia1, M. Rotman1, Y. Lee1, P. Han1, M. Schwartz1,2, W. Choi3, C. Gasson4, K. Choi1 SUNY Downstate Medical Center, Brooklyn, NY, 2Kings County Hospital Center, Brooklyn, NY, 3Beth Israel Medical Center, Manhattan, NY, 4Albany Radiation Oncology Associates, LLC, Albany, NY 1
Purpose/Objective(s): Primary treatment of endometrial cancer is surgical, but adjuvant radiation therapy (RT) and chemotherapy (CT) have been shown to decrease the incidence of locoregional recurrences. Despite current treatments including postoperative