Abstracts / Gynecologic Oncology 141 (2016) 2–208
196 – Poster
Pelvic and para-aortic lymph node mapping to diagnose
micrometastasis by injection of indocyanine green in endometrial
cancer
K. Nakamura, M. Iijima, Y. Ibuki, K. Kogure, K. Kigure, T. Nishimura, T.
Kanuma. Gunma Prefectural Cancer Center, Ota, Japan
Objectives: The therapeutic benefit of lymphadenectomy for endo-
metrial cancer is debated. However, the presence of lymph node
metastasis obviously compromises overall survival. At this point,
the clinical significance of micrometastasis in lymph nodes remains
unclear. The aim of this study was to assess the feasibility of detecting
micrometastasis using fluorescence near-infrared imaging of indocy-
anine green (ICG) with laparotomy.
Methods: Since July 2014, 32 patients were enrolled for lymph node
mapping. ICG, 1.25 mg, was injected into the cervical stroma at the 3
o’clock and 9 o’clock positions in patients who had pelvic lymphad-
enectomy (PLA) (n = 32) or both pelvic and para-aortic lymphade-
nectomy (PLA + PAN) (n = 13) and into the uterine fundal subserosa
close to the beginnings of the bilateral tubes for patients who had PAN.
PAN was performed in patients who were preoperatively diagnosed
as histologically G3, serous, or clear cell adenocarcinoma and/or outer
half of muscle invasion. ICG-stained lymph nodes detected with ICG
fluorescence imaging camera during open abdominal surgery were
sectioned 3-μm thick at 2-mm intervals for standard (H&E) staining.
The section suspected to be micrometastasis was analyzed with
immunohistochemistry using anticytokeratin antibody. Data were
obtained for the number and location of ICG-stained lymph nodes, and
the pathologic characteristics were also analyzed.
Results: ICG-stained lymph nodes were detected in all patients
enrolled in this study. Twenty-one (65.6%) and 8 patients (61.5%)
had bilateral pelvic or aortic ICG-stained lymph nodes, respectively.
DP
A median of 2.8 and 6.1 lymph nodes per patient was identified
TE
for PLA and PLA + PAN, respectively. Seven patients (22.6%) had
EC
RR
CO
UN
Fig. 1. Anatomic Distribution of ICN-stained Lymph Node.
81
lymph node metastasis, and 6 of these had metastasis in ICG-stained
lymph node (85.7% sensitivity). Furthermore, 3 patients among them
were diagnosed as having micrometastasis. No adverse events were
identified. (See Fig. 1.)
Conclusions: Despite the small sample size, fluorescence imaging
with ICG through intraoperative injection into the cervix and uterine
fundus is a feasible method to detect micrometastasis. The results
drawn in this study provide useful information for future study to
consider patient management with micrometastasis by the expan-
ding sample size and evaluating patient outcomes.
doi:10.1016/j.ygyno.2016.04.228
197 – Poster
Ovarian carcinosarcoma: A multi-institutional review of cases,
OF
treatment, and survival
L.C. Parsonsa, S.A. Sullivanb, C. Garciaa, T. Castellanob, V.L. Bae-Jumpb,
C.N. Landen Jr.a, L.A. Cantrella. aUniversity of Virginia School of
Medicine, Charlottesville, VA, USA, bUniversity of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
RO
Objectives: Given the rarity of ovarian carcinosarcoma, we sought
to analyze a contemporary multi-institutional case series of ovarian
carcinosarcoma to better understand patient characteristics and
outcomes of this rare epithelial ovarian cancer.
Methods: After institutional review board approval was obtained,
a retrospective review was performed to identify all women diag-
nosed with ovarian carcinosarcoma between 2000 and 2015 at the
University of Virginia and the University of North Carolina. Patient
characteristics and clinical history were abstracted from longitudinal
medical records. Statistical analysis was performed with SPSS. The
association between independent prognostic variables and overall
survival was examined using Fisher exact test and independent
samples t tests. Progression-free survival and overall survival were
analyzed using Kaplan-Meier estimates.
Results: Forty-two patients were identified with a mean age at
diagnosis of 65.4 years (standard deviation [SD], 12.5). Most patients
were Caucasian (90.5%) with a mean body mass index of 27.0 kg/m2
(SD 7.6) and baseline CA-125 level of 615.4 kU/L (SD 980.4). The
majority (62%) of cases were FIGO stage IIIC or IV at diagnosis.
All patients underwent surgical debulking and the majority (83%)
received adjuvant chemotherapy. Of those treated with chemother-
apy, 74% received carboplatin and paclitaxel. The median follow-up
was 22.5 months (range, 1–165 mo). Fifty-two percent of patients
had documented recurrence at a median time of 12 months (range,
0.2–45 mo) (Fig. 1a). The most common site of recurrence was the
abdominal cavity (59.0%), followed by the pelvis (27.3%), then extra-
abdominal recurrences (13.6%). The median overall survival time
was 26 months (range, 0.5–147 mo) (Fig. 1b). The median overall
survival was higher for stage I (36.6 mo) than stage II-IV (16.8 mo).
Conclusions: As with all epithelial ovarian cancers, most patients
were diagnosed after menopause with late-stage tumors. Despite
Fig. 1. Kaplan-Meier Analyses of (a) Time to Recurrence and (b) Overall Survival
among Cases of Ovarian Carcinosarcoma Diagnosed at the University of Virginia and
the University of North Carolina-Chapel-Hill from 2000-2015.
82 Abstracts / Gynecologic Oncology 141 (2016) 2–208
consistent treatment modalities, most patients in this cohort only
survived slightly more than 2 years. Unlike uterine carcinosarcoma,
patients with ovarian carcinosarcoma from this cohort do not appear
to have more aggressive disease than the more common histologies
of epithelial ovarian cancer, which historically have a relapse rate of
80% to 85% for stage III disease. Further data pooling from multiple
institutions will be needed to better describe the survival character-
istics of this rare disease.
doi:10.1016/j.ygyno.2016.04.229
198 – Poster
Institutional experience using interstitial brachytherapy for the
treatment of primary and recurrent pelvic malignancies
B.E. Onderdonk, E.C. Daugherty, P.D. Aridgides, L. Du, M.J. Cunningham,
W.D. Bunn, R. Agarwal, S.S. Hahn. SUNY Upstate Medical University,
Syracuse, NY, USA
Objectives: The study aimed to assess the outcomes of patients at
a single institution with locally advanced primary and recurrent
pelvic malignancies treated with interstitial high or low dose rate
brachytherapy (BT) using a modified Syed-Neblett template.
Methods: Between 1996 and 2010, 60 patients with locally advanced
primary or recurrent pelvic malignancies were treated at a single
institution with interstitial BT using a modified Syed-Neblett tem-
plate. Thirty-three patients had primary malignancies, with 6.1%
being stage I, 33.3% stage II, 45.5% stage III, and 15.2% stage IV; the
remaining 27 patients had recurrent malignancies. Fifty-six received
external beam radiation therapy (EBRT) as part of their treatment
DP
course. The median EBRT, BT, and EBRT + BT doses were 45 Gy, 20
Gy, and 65 Gy, respectively. Thirty-eight patients received concur-
TE
rent chemotherapy with EBRT. Complete response (CR) was defined
as the absence of residual disease on first follow-up. Toxicity was
graded as per Radiation Therapy Oncology Group criteria.
Results: CR was achieved in 91%. For primary cancers at diagnosis,
5-year local control (LC), 5-year progression-free survival (PFS), and
EC
5-year overall survival (OS) were 65%, 64%, and 42%, respectively.
For recurrent cancers at diagnosis, 5-year LC, 5-year PFS, and 5-year
OS were 80%, 51%, and 37%, respectively. There was a significant
difference in both OS and PFS among different tumor sites (P b .05),
with vaginal cancers having the best 5-year OS (55%) and PFS (84%).
RR
There was a total of 1 acute toxicity more than grade 3, and 7 late
toxicities greater than grade 3 with no grade 5 toxicities.
Conclusions: Our series suggests that interstitial BT using a modified
Syed-Neblett template is a safe and effective treatment for primary
or recurrent pelvic malignancies. This technique allowed effective
CO
LC of tumor with preservation of bladder and rectal functions in
all except 2 of our patients. One developed a rectovaginal fistula,
and the other required long-term urethral catheterization. Further
studies regarding dosimetric predictors of toxicity, and continual
follow-up are ongoing to determine the long-term efficacy of this
approach.
UN
doi:10.1016/j.ygyno.2016.04.230
199 – Poster
Histone deacetylase as a promising therapeutic target in
endometrial stromal sarcoma
M.H. Baeka,b, S.W. Leea, J.Y. Parka, D.Y. Kima, C.C. Rhimb, D.S. Suha, J.H.
Kima, Y.M. Kima, Y.T. Kima, J.H. Nama. aUniversity of Ulsan College of
Medicine, ASAN Medical Center, Seoul, South Korea, bHallym University
Sacred Heart Hospital, Anyang, South Korea
Objectives: The purpose of this study was to investigate the expres-
sion of histone deacetylase (HDAC) in endometrial stromal sarcoma
(ESS).
Methods: Forty-one patients with ESS were eligible for the study.
The immunohistochemical expression of HDAC was analyzed using
tissue microarrays. Prognostic impact of clinicopathologic character-
istics of patients and treatment methods were also investigated.
Results: Strong positive immune reaction was observed in 32 (78.0%),
23 (56.1%), 8 (19.5%), 36 (87.8%), 7 (17.1%), 30 (73.2%), 31 (75.6%),
and 33 (80.5%) of HDAC 1, 2, 3, 4, 5, 6, 7, and 8 in ESS. Adjuvant therapy
and radicality of surgery had no statistical relevance with disease-free
and overall survival outcomes. Although not statistically significant,
HDAC 1, 4, 6, 7, and 8 showed high frequency of strong immune
reaction and a lower disease-free survival rates (100.0% vs 81.3%,
P = .202; 100.0% vs 83.3%, P = .393; 90.9% vs 83.3%, P = .579; 90.0%
vs 83.9%; and 100.0% vs 81.8%, P = .207).
OF
Conclusions: All of the HDAC series were frequently expressed in ESS.
Target therapy for HDAC1, 4, 6, 7, and 8, which especially showed
high frequency of strong immunoreactivity, can be considered to be a
promising therapeutic target to improve prognosis.
RO
doi:10.1016/j.ygyno.2016.04.231
200 – Poster
Financial toxicity among privately insured gynecologic oncology
patients: Silent barriers to care
E.L. Barbera, J.T. Bensena, A.C. Snavelyb, P.A. Gehriga, K.M. Dolla,c.
a
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, bPD
Stat LLC, Chapel Hill, NC, USA, cUniversity of North Carolina Lineberger
Comprehensive Cancer Center, Chapel Hill, NC, USA
Objectives: Patient-reported financial barriers to care are associated
with poor cancer outcomes. Private insurance may protect against
some financial barriers; however, out-of-pocket costs can be sig-
nificant and prohibitive. We estimated the prevalence of financial
barriers to care among women with private insurance presenting for
gynecologic oncologic surgery.
Methods: Patients seeking surgical management at a tertiary care
gynecologic oncology clinic were enrolled in a prospective cohort
study from September 30, 2013 to October 6, 2014. They were
administered a survey addressing financial and access-driven barriers
to care. Demographics and medical factors were obtained from
the medical record and comorbidities quantified using the Charlson
comorbidity (CC) index. Χ2 tests, ttests, and multivariable logistic
regression were used.
Results: Of the 208 subjects, 84.1% (n = 175) had private insurance,
7.2% (n = 15) were uninsured, and 8.7% had Medicare/Medicaid
alone (n = 18). Median age was 58 years (range, 22–93 years).
Among privately insured patients, 59 (33.7%) experienced a financial
barrier to care: 54 (30.9%) delayed health care in the last year
because of financial barriers and 24 (13.7%) did not get needed
health care services, such as medications, because of inability to
afford them. Younger age was associated with both financially driven
delays (53.5 vs 58.3 years, P = .03) and inability to afford services
(48.1 vs 58.2 years, P b .001). Black patients were more likely to
experience financial barriers (delays, 48.3% vs 27.4%, P = .03;
services, 34.5% vs 9.6% P b .001), as were obese patients (body mass
index N30) (services, 20.2% vs 7.0%, P = .01). Patients reporting
financial barriers had lower mean CC scores (delays, 1.9 vs 2.5,
P = .04; services, 1.1 vs 2.5, P = .002). On multivariable analysis,
nonwhite race (odds ratio [OR] 4.4, 95% CI 1.6–12.2), each 5-year
decrease in age (OR 1.2, 95% CI 1.01–1.5), and each 1-point decrease
in CC score (OR 1.5, 95% CI 1.03–2.1) remained associated with
inability to afford services.