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Survival Outcome of Cervical Cancer Patients Staged With Magnetic Resonance Imaging
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Volume 96 Number 2S Supplement 2016 tumor histologies, data for gynecologic neoplasms is limited, often grouping patients with gynecologic primaries with multiple other histologies. Here we aim to exclusively study gynecologic histologies and, in doing so, provide a more focused characterization of their outcomes in the metastatic disease setting. Materials/Methods: A retrospective analysis was conducted of patients with metastatic gynecologic neoplasms whose lesions were first managed via site-directed radiotherapies at our institution between 2002 and 2014. Among the criteria for inclusion were pathologically confirmed neoplastic disease, pathologic (preferred) or radiologic evidence of Stage IV/M1 disease, limited metastatic burden of disease, and follow up imaging after the completion of radiation therapy to assess for control of disease and survival. Results: Twenty-nine patients met inclusion criteria, ranging from 42 to 85 years old at treatment onset, with a total of 34 lesions studied over a median follow up time of 13 months after treatment. Of these, 19 were endometrial in origin while 11 were ovarian. Major tumor histologies included adenocarcinoma (21), sarcoma (6), and squamous cell carcinoma (5). Prior to developing Stage IV disease, lesions were often treated definitively with surgery (32), chemotherapy (31), and/or external beam radiation therapy (22). Metachronous metastatic disease was most often first observed in the lungs (11), brain (10) and liver (7) with initial treatment mainly reliant on stereotactic techniques: SBRT (17) and SRS (9). A median biologically effective dose of 48 Gy (range: 11-132) was calculated using an alpha/beta ratio of ten. Median overall survival (OS), local control (LC), and time to distant failure (DF) were 18 (range: 1-141), 8 (range: 0-63), and 5 (range: 1-95) months, respectively, from the time of completing the initial course of radiation therapy. Distant failures most commonly involved the lung (18), liver (6), and brain (5). Histologyspecific parameters, the impact of definitive and adjuvant treatments prior to Stage IV diagnosis as well as subsequent to these initial radiotherapeutic interventions will also be presented. Conclusion: These results provide a glimpse into the benefits expected in managing gynecologic neoplastic disease with limited metastases and may help guide future studies or management of patients with advanced gynecologic malignancies. Author Disclosure: N.J. DeNunzio: Resident; University of Rochester Medical Center, University of Rochester. D.P. Bergsma: Employee; University of Rochester Medical Center. Resident; University of Rochester Medical Center. M.T. Milano: Director of residency program; University of Rochester Medical Center.
2788 Survival Outcome of Cervical Cancer Patients Staged With Magnetic Resonance Imaging J. Kim, J. Lee, K.J. Lee, Y. Kim, W. Jung, and R. Lee; Ewha Womans University Medical Center, Seoul, Korea, The Republic of Korea Purpose/Objective(s): According to the revised FIGO staging, the use of diagnostic imaging, including MRI, is recommended. The purpose of this study is to analyze the treatment outcome of cervical cancer patients who had parametrial invasion on the MR imaging. Materials/Methods: Between 2000 and 2015, 259 patients who were diagnosed with uterine cervical cancer FIGO stage IB-IIB by clinical examination and treated with definitive or postoperative radiation were included. One hundred twenty five patients with stage IIB received concurrent chemoradiation (CCRT group) and 134 patients with stage IB-IIA underwent surgery followed by radiation (post-op RT group). Parametrial invasion on the MRI was found in 87 out of 125 CCRT group and 32 out of 134 post-op RT group. Results: The median follow-up period of all patients was 57 months (range 9-183 months). There was no statistical difference in patients’ characteristics (age, tumor size, lymph node metastasis, histology, and use of chemotherapy) between the two groups. Five-year overall survival for the CCRT group and post-op RT group were 80.3% and 89.4%, respectively (P Z 0.638). Five-year disease-free survival (DFS) for the CCRT group and post-op RT group were 71.9% and 52.5%, respectively (P Z 0.034) and 5-
year distant metastasis-free survival (DMFS) were 79.0% and 59.1% (P Z 0.038). Conclusion: We found that CCRT resulted in better DFS and DMFS than postoperative radiation in cervical cancer patients with positive parametrial invasion on the MRI despite of higher clinical staging. Author Disclosure: J. Kim: None. J. Lee: None. K. Lee: None. Y. Kim: None. W. Jung: None. R. Lee: None.
2789 Prognostic Factors Associated With Survival In Melanoma Of The Vulva And Vagina J.K. McCool,1 B. Anderson,1 A. Guirguis,1 E. Katsoulakis,2 K.J. Parikh,2 and H. Ashamalla1; 1New York Methodist Hospital, Brooklyn, NY, 2New York Methodist Hospital, Brooklyn, NY, United States Purpose/Objective(s): To determine the prognostic factors affecting the risk of mortality in women with vulvar and vaginal melanoma. Materials/Methods: Data was obtained from the Surveillance, Epidemiology, and End Result (SEER) registry for 623 women diagnosed with primary vulvar or vaginal melanoma from 2004 to 2011. Patient demographic and disease characteristics including age, race, marital status, tumor stage, surgery, and use of radiation therapy were obtained and evaluated using Kaplan-Meier survival curves and Cox regression models for analysis. Results: We found data for 460 women with vulvar melanoma and 163 women with vaginal melanoma. The mean age of diagnosis was 67 years. The majority of cases occurred in white women (90.4%) versus African American (4%) or other races (5%). Of all patients, only 18.3% underwent radiation therapy to the primary site, with 60% of those women receiving RT in the adjuvant setting following resection. There were 255 surviving patients, but 42% mortality due to vulvar or vaginal melanoma. Survival was worse in patients with primary vagina vs. vulvar melanoma (17% vs. 53%). The mean survival was 31 months, with 5-year disease specific survival of 21% vs. 50% in patients receiving radiation vs. no radiation respectively. Conclusion: Patients with vaginal melanoma have far worse survival rates that vulvar melanoma. Interestingly, patients receiving radiation therapy to the primary site had worse survival, though these patients likely had worse prognostic features at presentation. Further multivariate analysis will need to be performed to assess features associated with worse outcomes. Author Disclosure: J.K. McCool: None. B. Anderson: None. A. Guirguis: None. E. Katsoulakis: None. K.J. Parikh: None. H. Ashamalla: None.
2790 Early Clinical Outcomes of Stereotactic Body Radiation Therapy (SBRT) for Oligometastatic Gynecological Malignancies S. Mesko1 and M. Kamrava2; 1University of California Irvine, Orange, CA, 2University of California, Los Angeles, Los Angeles, CA Purpose/Objective(s): Given the limited data on appropriate doses and outcomes of stereotactic body radiation therapy (SBRT) for oligometastatic ( 5 sites) disease, we reviewed our early clinical outcomes with SBRT for oligometastatic gynecological malignancies. Materials/Methods: An IRB-approved retrospective study was performed on 28 consecutive women with oligometastatic gynecologic malignancies treated with SBRT between 2009 and 2015. The distribution of primary sites were 15 ovarian, 9 endometrial, 2 cervical, and 2 vaginal. Median age was 66.5 years (range 52-81). 47% (13/28) of patients had radiation therapy as part of their primary disease treatment, with 5 of these 13 (38%) experiencing in-field recurrence. A median of 1 target lesion (range 1-4) per patient was treated with SBRT for a total of 47 targets. Target sites were 42% lymph node, 22% lung, 19% pelvic soft tissue, and 17% liver. A median of 8 Gy/fraction (5-18) and 5 fractions (1-10) were delivered for median total dose of 40 Gy (16-54). RECIST v1.1 criteria were used to determine response rates for each target lesion on post-treatment PET/CT. Rates of local/distant failure and progression free survival (PFS) were
Volume 96 Number 2S Supplement 2016 tumor histologies, data for gynecologic neoplasms is limited, often grouping patients with gynecologic primaries with multiple other histologies. Here we aim to exclusively study gynecologic histologies and, in doing so, provide a more focused characterization of their outcomes in the metastatic disease setting. Materials/Methods: A retrospective analysis was conducted of patients with metastatic gynecologic neoplasms whose lesions were first managed via site-directed radiotherapies at our institution between 2002 and 2014. Among the criteria for inclusion were pathologically confirmed neoplastic disease, pathologic (preferred) or radiologic evidence of Stage IV/M1 disease, limited metastatic burden of disease, and follow up imaging after the completion of radiation therapy to assess for control of disease and survival. Results: Twenty-nine patients met inclusion criteria, ranging from 42 to 85 years old at treatment onset, with a total of 34 lesions studied over a median follow up time of 13 months after treatment. Of these, 19 were endometrial in origin while 11 were ovarian. Major tumor histologies included adenocarcinoma (21), sarcoma (6), and squamous cell carcinoma (5). Prior to developing Stage IV disease, lesions were often treated definitively with surgery (32), chemotherapy (31), and/or external beam radiation therapy (22). Metachronous metastatic disease was most often first observed in the lungs (11), brain (10) and liver (7) with initial treatment mainly reliant on stereotactic techniques: SBRT (17) and SRS (9). A median biologically effective dose of 48 Gy (range: 11-132) was calculated using an alpha/beta ratio of ten. Median overall survival (OS), local control (LC), and time to distant failure (DF) were 18 (range: 1-141), 8 (range: 0-63), and 5 (range: 1-95) months, respectively, from the time of completing the initial course of radiation therapy. Distant failures most commonly involved the lung (18), liver (6), and brain (5). Histologyspecific parameters, the impact of definitive and adjuvant treatments prior to Stage IV diagnosis as well as subsequent to these initial radiotherapeutic interventions will also be presented. Conclusion: These results provide a glimpse into the benefits expected in managing gynecologic neoplastic disease with limited metastases and may help guide future studies or management of patients with advanced gynecologic malignancies. Author Disclosure: N.J. DeNunzio: Resident; University of Rochester Medical Center, University of Rochester. D.P. Bergsma: Employee; University of Rochester Medical Center. Resident; University of Rochester Medical Center. M.T. Milano: Director of residency program; University of Rochester Medical Center.
2788 Survival Outcome of Cervical Cancer Patients Staged With Magnetic Resonance Imaging J. Kim, J. Lee, K.J. Lee, Y. Kim, W. Jung, and R. Lee; Ewha Womans University Medical Center, Seoul, Korea, The Republic of Korea Purpose/Objective(s): According to the revised FIGO staging, the use of diagnostic imaging, including MRI, is recommended. The purpose of this study is to analyze the treatment outcome of cervical cancer patients who had parametrial invasion on the MR imaging. Materials/Methods: Between 2000 and 2015, 259 patients who were diagnosed with uterine cervical cancer FIGO stage IB-IIB by clinical examination and treated with definitive or postoperative radiation were included. One hundred twenty five patients with stage IIB received concurrent chemoradiation (CCRT group) and 134 patients with stage IB-IIA underwent surgery followed by radiation (post-op RT group). Parametrial invasion on the MRI was found in 87 out of 125 CCRT group and 32 out of 134 post-op RT group. Results: The median follow-up period of all patients was 57 months (range 9-183 months). There was no statistical difference in patients’ characteristics (age, tumor size, lymph node metastasis, histology, and use of chemotherapy) between the two groups. Five-year overall survival for the CCRT group and post-op RT group were 80.3% and 89.4%, respectively (P Z 0.638). Five-year disease-free survival (DFS) for the CCRT group and post-op RT group were 71.9% and 52.5%, respectively (P Z 0.034) and 5-
year distant metastasis-free survival (DMFS) were 79.0% and 59.1% (P Z 0.038). Conclusion: We found that CCRT resulted in better DFS and DMFS than postoperative radiation in cervical cancer patients with positive parametrial invasion on the MRI despite of higher clinical staging. Author Disclosure: J. Kim: None. J. Lee: None. K. Lee: None. Y. Kim: None. W. Jung: None. R. Lee: None.
2789 Prognostic Factors Associated With Survival In Melanoma Of The Vulva And Vagina J.K. McCool,1 B. Anderson,1 A. Guirguis,1 E. Katsoulakis,2 K.J. Parikh,2 and H. Ashamalla1; 1New York Methodist Hospital, Brooklyn, NY, 2New York Methodist Hospital, Brooklyn, NY, United States Purpose/Objective(s): To determine the prognostic factors affecting the risk of mortality in women with vulvar and vaginal melanoma. Materials/Methods: Data was obtained from the Surveillance, Epidemiology, and End Result (SEER) registry for 623 women diagnosed with primary vulvar or vaginal melanoma from 2004 to 2011. Patient demographic and disease characteristics including age, race, marital status, tumor stage, surgery, and use of radiation therapy were obtained and evaluated using Kaplan-Meier survival curves and Cox regression models for analysis. Results: We found data for 460 women with vulvar melanoma and 163 women with vaginal melanoma. The mean age of diagnosis was 67 years. The majority of cases occurred in white women (90.4%) versus African American (4%) or other races (5%). Of all patients, only 18.3% underwent radiation therapy to the primary site, with 60% of those women receiving RT in the adjuvant setting following resection. There were 255 surviving patients, but 42% mortality due to vulvar or vaginal melanoma. Survival was worse in patients with primary vagina vs. vulvar melanoma (17% vs. 53%). The mean survival was 31 months, with 5-year disease specific survival of 21% vs. 50% in patients receiving radiation vs. no radiation respectively. Conclusion: Patients with vaginal melanoma have far worse survival rates that vulvar melanoma. Interestingly, patients receiving radiation therapy to the primary site had worse survival, though these patients likely had worse prognostic features at presentation. Further multivariate analysis will need to be performed to assess features associated with worse outcomes. Author Disclosure: J.K. McCool: None. B. Anderson: None. A. Guirguis: None. E. Katsoulakis: None. K.J. Parikh: None. H. Ashamalla: None.
2790 Early Clinical Outcomes of Stereotactic Body Radiation Therapy (SBRT) for Oligometastatic Gynecological Malignancies S. Mesko1 and M. Kamrava2; 1University of California Irvine, Orange, CA, 2University of California, Los Angeles, Los Angeles, CA Purpose/Objective(s): Given the limited data on appropriate doses and outcomes of stereotactic body radiation therapy (SBRT) for oligometastatic ( 5 sites) disease, we reviewed our early clinical outcomes with SBRT for oligometastatic gynecological malignancies. Materials/Methods: An IRB-approved retrospective study was performed on 28 consecutive women with oligometastatic gynecologic malignancies treated with SBRT between 2009 and 2015. The distribution of primary sites were 15 ovarian, 9 endometrial, 2 cervical, and 2 vaginal. Median age was 66.5 years (range 52-81). 47% (13/28) of patients had radiation therapy as part of their primary disease treatment, with 5 of these 13 (38%) experiencing in-field recurrence. A median of 1 target lesion (range 1-4) per patient was treated with SBRT for a total of 47 targets. Target sites were 42% lymph node, 22% lung, 19% pelvic soft tissue, and 17% liver. A median of 8 Gy/fraction (5-18) and 5 fractions (1-10) were delivered for median total dose of 40 Gy (16-54). RECIST v1.1 criteria were used to determine response rates for each target lesion on post-treatment PET/CT. Rates of local/distant failure and progression free survival (PFS) were