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P1120 Management of ovarian clear cell carcinoma in pregnancy. A report of 2 cases with review of literature
S726
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Results: The study included 110 patients. 80 (72%) had benign and the rest malignant disease. Mean age of patients with malignancy was 49 years and for benign 36 years (p = 0.0001). 11 patients with benign tumors were asymptomatic, while 66% had abdominal pain. On the other hand 70% patients with ovarian malignancy had abdominal symptoms with abdominal pain in (76%). Abdominal enlargement and abdominal mass were significantly more in malignant tumors (p = 0.003, p = 0.005). Gastrointestinal symptoms were present in both groups but more significant in malignant group (p = 0.004). Constitutional symptoms like loss of appetite and weight loss were only present in malignant group (p = 0.001). 70% of the malignant tumors presented at late stage (III & IV). Histopathology of benign tumors revealed follicular/ luteal cyst in 32% of cases while serous cyst adenoma in 23%. Histopathology of malignant tumors revealed serous cyst carcinoma in 46.7% and mucinous cyst carcinoma in 26% of cases. Conclusions: Ovarian malignancy is a silent killer, especially affecting women above 50. Although presentation is often vague and non specific, symptoms are definitely present. Therefore a proper bimanual examination and appropriate investigations should be done at the outset in post menopausal women. P1119 Comparative study of neoadjuvant intravenous versus intraarterial chemotherapy versus brachytherapy followed by radical surgery versus radical surgery alone in stage IB2–IIA bulky cervical cancers: a phase III randomized clinical trial in Shanghai X. Wu1 , G. Ke1 , X. Huang1 , S. Cai1 , R. Zang1 , H. Wang1 , Y. Feng2 , Z. Li1 . 1 Department of Gynecologic Oncology, Cancer Hospital of Fudan University, Shanghai 200032, China, 2 Gynecological Department, Gynecologic and Obstetric Hospital of Fudan University, Shanghai 200011, China Objective: To determine the effectiveness of neoadjuvant chemotherapy or radiotherapy followed by radical surgery relative to radical surgery alone in stage IB2–IIA bulky cervical cancer with tumor diameter greater 4 cm. Method: From January 2006 to May 2008, 99 patients were randomly assigned to 4 groups: (1) cisplatin 50 mg/m2 plus 5-fluorouracil 750 mg/m2 via vein every 2 weeks for two courses (IVCT); (2) the same regimen as IVCT but via internal iliac artery or uterine artery (IACT); (3) brachytherapy with 1500 cGy/ 3 fraction/1.5 weeks at point A (BT); following those adjuvant therapies, the patients received radical hysterectomy plus pelvic and paraaortic lymadenectomy; (4) immediate the radical surgery without adjuvant therapy (RS). Results: The response rates (RR) for reduction of cervical tumor were 31.6% in IVCT, 64.0% in IACT, 54.5% in NBT, respectively. The RR in IACT was highest (p < 0.01) with complete response of 20%. Lymph node metastasis found pathologically significantly decreased in neoadjuvant therapy groups (21% in IVCT, 28% IACT, 27.1% BT)comparing with RS(47.8%, p = 0.05). There was not different in lymphovascular space involvement among the four groups. Grade 3 neutropenia was more frequent with IVCH and IACT. And the most expensive neoadjuvant therapy was IACT. At a median follow-up of 12 months, 5 women experienced disease died. But the progressionfree survival is pending. Conclusion: Among the three kind of neoadjuvant therapy the IACT regiment is associated with a highest RR. Neoadjuvant therapies may reduce positive finding of lymph node but their survival benefit is pending.
P1120 Management of ovarian clear cell carcinoma in pregnancy. A report of 2 cases with review of literature K. Yam, R. Namuduri, Y. Chia, Y. Lim. KK Women’s and Children’s Hospital We reported two cases of ovarian clear cell carcinoma in pregnancy, managed in our centre. Ovarian cancer in pregnancy is uncommon and management is complex. Management depends on the stage of cancer, whether the patient intends to keep her pregnancy as well as future fertility wishes. Options include complete staging procedure, or conservative surgical approaches such as cystectomy/unilateral salpingo-oophorectomy, with pelvic lymph node dissection and omentectomy. Both cases were Stage 1C clear cell carcinoma of the ovary. In our 1st case the patient was diagnosed in the 2nd trimester of pregnancy and she underwent open cystectomy followed by administration of 4 cycles of Cisplatin. She delivered prematurely for PPROM at 27 weeks via cesarean section followed by TH BSO, staging procedure and chemotherapy. Both mother and child are doing well after 7 years of follow up. 2nd case was diagnosed in the 1st trimester of pregnancy and she underwent termination of pregnancy followed by conservative surgical staging with, left salpingo-oophorectomy followed by administration of 6 cycles of Cisplatin and Cyclophosphamide. Subsequently patient had 2 normal deliveries and currently under follow up for 6 years without recurrence. Case discussion and review of literature was done. P1121 The significance of different management of primary cytoreductive surgery in advanced stage epithelial ovarian cancer X. Yan, Y. Gao, G. Jiang, M. Gao, N. An Objective: Aggressive tumour cytoreduction has been an accepted part of the management of advanced ovarian carcer for over three decades. The objective of this study was to determine the survival difference of different management of primary cytoreductive surgery for women diagnosed with advanced stage epithelial ovarian cancer. Methods: A retrospectively kept database was used to identify and review the records of all pts with advanced stage EOC who underwent primary cytoreductive surgery at our hospital between January 2000 and December 2005. All patients were divided into two groups: cytoreduction with hysterectomy and lymphedenectomy; cytoreduction without hysterectomy and lymphecenectomy. Results: The study cohort included 196 pts. The median age was 63 years (range, 25–83), and the median follow-up was 38 months (range, 1–132). Median overall survival in relation to the two groups was: study group, 41 months; control group, 33 months. Statistical comparison between the two groups without significantly different survival rates (P > 0.05). Conclusion: Our data suggest that removal of uterus and pelvic lymphnode without macroscopic disease isn’t associated with prolonged survival. In order to reduce extra damage to the patients, these procedure should be omitted from the primary cytoreductive surgery. P1122 The necessity of high level para-aortic lymph node dissection in endometrial cancer Y. Yang, C. Wong. Mackay Memorial Hospital, Taipei, Taiwan Purpose: To retrospectively assess effects of the extent of paraaortic lymphadenectomy on outcomes of endometrial cancer patients.
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Results: The study included 110 patients. 80 (72%) had benign and the rest malignant disease. Mean age of patients with malignancy was 49 years and for benign 36 years (p = 0.0001). 11 patients with benign tumors were asymptomatic, while 66% had abdominal pain. On the other hand 70% patients with ovarian malignancy had abdominal symptoms with abdominal pain in (76%). Abdominal enlargement and abdominal mass were significantly more in malignant tumors (p = 0.003, p = 0.005). Gastrointestinal symptoms were present in both groups but more significant in malignant group (p = 0.004). Constitutional symptoms like loss of appetite and weight loss were only present in malignant group (p = 0.001). 70% of the malignant tumors presented at late stage (III & IV). Histopathology of benign tumors revealed follicular/ luteal cyst in 32% of cases while serous cyst adenoma in 23%. Histopathology of malignant tumors revealed serous cyst carcinoma in 46.7% and mucinous cyst carcinoma in 26% of cases. Conclusions: Ovarian malignancy is a silent killer, especially affecting women above 50. Although presentation is often vague and non specific, symptoms are definitely present. Therefore a proper bimanual examination and appropriate investigations should be done at the outset in post menopausal women. P1119 Comparative study of neoadjuvant intravenous versus intraarterial chemotherapy versus brachytherapy followed by radical surgery versus radical surgery alone in stage IB2–IIA bulky cervical cancers: a phase III randomized clinical trial in Shanghai X. Wu1 , G. Ke1 , X. Huang1 , S. Cai1 , R. Zang1 , H. Wang1 , Y. Feng2 , Z. Li1 . 1 Department of Gynecologic Oncology, Cancer Hospital of Fudan University, Shanghai 200032, China, 2 Gynecological Department, Gynecologic and Obstetric Hospital of Fudan University, Shanghai 200011, China Objective: To determine the effectiveness of neoadjuvant chemotherapy or radiotherapy followed by radical surgery relative to radical surgery alone in stage IB2–IIA bulky cervical cancer with tumor diameter greater 4 cm. Method: From January 2006 to May 2008, 99 patients were randomly assigned to 4 groups: (1) cisplatin 50 mg/m2 plus 5-fluorouracil 750 mg/m2 via vein every 2 weeks for two courses (IVCT); (2) the same regimen as IVCT but via internal iliac artery or uterine artery (IACT); (3) brachytherapy with 1500 cGy/ 3 fraction/1.5 weeks at point A (BT); following those adjuvant therapies, the patients received radical hysterectomy plus pelvic and paraaortic lymadenectomy; (4) immediate the radical surgery without adjuvant therapy (RS). Results: The response rates (RR) for reduction of cervical tumor were 31.6% in IVCT, 64.0% in IACT, 54.5% in NBT, respectively. The RR in IACT was highest (p < 0.01) with complete response of 20%. Lymph node metastasis found pathologically significantly decreased in neoadjuvant therapy groups (21% in IVCT, 28% IACT, 27.1% BT)comparing with RS(47.8%, p = 0.05). There was not different in lymphovascular space involvement among the four groups. Grade 3 neutropenia was more frequent with IVCH and IACT. And the most expensive neoadjuvant therapy was IACT. At a median follow-up of 12 months, 5 women experienced disease died. But the progressionfree survival is pending. Conclusion: Among the three kind of neoadjuvant therapy the IACT regiment is associated with a highest RR. Neoadjuvant therapies may reduce positive finding of lymph node but their survival benefit is pending.
P1120 Management of ovarian clear cell carcinoma in pregnancy. A report of 2 cases with review of literature K. Yam, R. Namuduri, Y. Chia, Y. Lim. KK Women’s and Children’s Hospital We reported two cases of ovarian clear cell carcinoma in pregnancy, managed in our centre. Ovarian cancer in pregnancy is uncommon and management is complex. Management depends on the stage of cancer, whether the patient intends to keep her pregnancy as well as future fertility wishes. Options include complete staging procedure, or conservative surgical approaches such as cystectomy/unilateral salpingo-oophorectomy, with pelvic lymph node dissection and omentectomy. Both cases were Stage 1C clear cell carcinoma of the ovary. In our 1st case the patient was diagnosed in the 2nd trimester of pregnancy and she underwent open cystectomy followed by administration of 4 cycles of Cisplatin. She delivered prematurely for PPROM at 27 weeks via cesarean section followed by TH BSO, staging procedure and chemotherapy. Both mother and child are doing well after 7 years of follow up. 2nd case was diagnosed in the 1st trimester of pregnancy and she underwent termination of pregnancy followed by conservative surgical staging with, left salpingo-oophorectomy followed by administration of 6 cycles of Cisplatin and Cyclophosphamide. Subsequently patient had 2 normal deliveries and currently under follow up for 6 years without recurrence. Case discussion and review of literature was done. P1121 The significance of different management of primary cytoreductive surgery in advanced stage epithelial ovarian cancer X. Yan, Y. Gao, G. Jiang, M. Gao, N. An Objective: Aggressive tumour cytoreduction has been an accepted part of the management of advanced ovarian carcer for over three decades. The objective of this study was to determine the survival difference of different management of primary cytoreductive surgery for women diagnosed with advanced stage epithelial ovarian cancer. Methods: A retrospectively kept database was used to identify and review the records of all pts with advanced stage EOC who underwent primary cytoreductive surgery at our hospital between January 2000 and December 2005. All patients were divided into two groups: cytoreduction with hysterectomy and lymphedenectomy; cytoreduction without hysterectomy and lymphecenectomy. Results: The study cohort included 196 pts. The median age was 63 years (range, 25–83), and the median follow-up was 38 months (range, 1–132). Median overall survival in relation to the two groups was: study group, 41 months; control group, 33 months. Statistical comparison between the two groups without significantly different survival rates (P > 0.05). Conclusion: Our data suggest that removal of uterus and pelvic lymphnode without macroscopic disease isn’t associated with prolonged survival. In order to reduce extra damage to the patients, these procedure should be omitted from the primary cytoreductive surgery. P1122 The necessity of high level para-aortic lymph node dissection in endometrial cancer Y. Yang, C. Wong. Mackay Memorial Hospital, Taipei, Taiwan Purpose: To retrospectively assess effects of the extent of paraaortic lymphadenectomy on outcomes of endometrial cancer patients.