ABSTRACTS OF PAPERS GOC RÉSUMÉS DES PRÉSENTATIONS GOC

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1 ABSTRACTS OF PAPERS GOC RÉSUMÉS DES PRÉSENTATIONS GOC O-GOC SIGNIFICANCE OF CA125 RESPONSE TO NEOADJUVANT CHEMOTHERAPY AND DELAYED PRIMARY SURGICAL DEBULKING IN EPITHELIAL OVARIAN CANCER L. Hopkins, W. Faught, M. Fung-Kee-Fung Objectives: To examine the prognostic significance of Ca125 response in ovarian cancer patients treated with neoadjuvant chemotherapy and delayed primary surgical debulking. Study Methods: Patients treated with neoadjuvant chemotherapy with primary intention to perform delayed surgical debulking were retrospectively reviewed. Ca125 response was assessed at two time points: prior to surgical debulking (response to neoadjuvant chemotherapy) and at the end of primary chemotherapy (further response to surgery and chemotherapy). Cox proportional hazard models were built to model progression free intervals using predictor variables of: age, cancer stage, tumour grade, residual disease, and Ca125 response. Results: Ninety one patients were included. Eighty three percent had more than 50% decrease of Ca125 from neoadjuvant treatment. Optimal debulking (<2 cm) was achieved in seventy four percent. Cox regressions revealed two significant predictive variables of time to first progression being: age (p=0.002) and residual disease (p=0.003). Ca125 response status to neoadjuvant chemotherapy was not significantly associated with progression free survivals. Ca125 response to surgery and further chemotherapy approached significant level in the model (p=0.068). Conclusions: The lack of Ca125 response after neoadjuvant chemotherapy is not an independent risk factor for recurrent disease. All patients treated with neoadjuvant chemotherapy should be offered aggressive debulking surgery regardless of the response to neoadjuvant treatment. O-GOC THE SIGNIFICANCE OF CHEMOTHERAPY INTERRUPTIONS FROM PLANNED DELAYED SURGICAL DEBULKING IN OVARIAN CANCER PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY K. Fathi, L. Hopkins, W. Faught, M. Fung-Kee-Fung Objectives: To examine the prognostic significance of chemotherapy interruptions from delayed primary surgical debulking following neoadjuvant chemotherapy. Study Methods: Retrospective chart review was carried out to identify patients who were treated with neoadjuvant chemotherapy. Standard patients demographics and detailed chemotherapy administration schedules were reviewed. Cox regression modeling was used to identify significant predictors of progression free and overall survival using well established prognostic variables and time delays between chemotherapy administrations peri operatively, stratified by residual disease status. Results: Ninety-seven patients were identified. All patients received three to four cycles of Carboplatinum/Paclitaxel before primary surgical debulking. The median delay from the last cycle of chemotherapy to surgery was 29 days (range days). The median delay from surgery to resumption of cytotoxic therapy was 23 days (range 8 65 days). Chemotherapy administrations were interrupted for a median of 50 days (range days) around the time of surgeries. No effect on progression free interval was observed by chemotherapy interruptions regardless of residual disease status. In sub optimally debulked patients, the estimated median overall survival for those with less than 6 weeks interruption between chemotherapy cycles was 69.2 months (95% CI ). The corresponding survival estimates in those with delays of more than 6 weeks was 21.3 months (95% CI ). Conclusions: Interruptions in chemotherapy administration were seen to adversely impact prognosis among sub optimally debulked ovarian cancer patients. O-GOC HISTOPATHOLOGIC ASSESSMENTS OF CHEMOTHERAPY EFFECTS IN OVARIAN CANCER PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY AND DELAYED PRIMARY SURGICAL DEBULKING K. William, M. Senterman, L. Hopkins, W. Faught, M. Fung-Kee-Fung Objectives: To assess the pathologic tumour response to neoadjuvant chemotherapy and its prognostic significance. Study Methods: Patients treated with neoadjuvant chemotherapy with intent to perform delayed primary surgical debulking were retrospectively reviewed. Pathologic assessments of tumour necrosis, fibrosis, macrophage response, and inflammation were recorded and graded on an ordinal scale of 0 to 2 (none/minimal, moderate, extensive) by one gynecologic pathologist. A composite pathologic tumour response score was calculated by summing all assessed pathologic variable. Cox proportional hazard models were built to model time to progression and death using predictor variables of: age, tumour grade, residual disease, and pathologic tumour response score. Results: Ninety nine patients with available slides for reviews were included. Optimal debulking was achieved in seventy four percent. Significant predictors for progression free survival included: age (p=0.05), amount of tumour residual (p=0.016), and the composite pathologic tumour response score (p= HR % CI ). Cox regression modeling revealed only one significant predictive variable of time to disease related death being the composite pathologic tumour response score (p=0.017 HR % CI ). The estimated median survival for the group was months (95% CI ). Conclusions: Pathologic assessments of tumour response to chemotherapy are helpful in determining prognosis and guide subsequent therapeutic decisions. The composite pathologic tumour response score require further study and validation. O-GOC RESIDUAL TUMOUR >1 CM FOLLOWING DEBULKING SURGERY AFTER NEOADJUVANT CHEMOTHERAPY PREDICTS POOR CLINICAL OUTCOME IN ADVANCED STAGE OVARIAN CANCER (FIGOIIIC-IV) D. de Jong Princess Margaret Hospital, Gynecology Oncology, 610 University Avenue, Toronto, ON, M5G 2M9, Canada M. Verhulsdonk, M. van der Burg, C. Burger Objectives: To compare survival between patients who had neoadjuvant chemotherapy versus upfront cytoreductive surgery S56 MAY JOGC MAI 2008

2 for advanced ovarian cancer based on a diagnostic, pretreatment surgical procedure. Study Methods: Prospective observational study was performed between 1995 and 2005: 51 advanced ovarian cancer patients underwent diagnostic surgery. If patients were deemed resectable they underwent upfront cytoreductive surgery, otherwise they received 3 cycles of neoadjuvant chemotherapy prior to cytoreductive surgery. Median follow-up was 32 months. Chi-square, Kaplan-Meier and Cox regression analysis were utilized. Results: Following diagnostic surgery, 26 patients underwent upfront debulking (Group A) and 25 received neoadjuvant chemotherapy (Group B). Positive predictive value for optimal debulking by pre-treatment evaluation was 57.7%. Median survival for patients in Group A was 27 months compared to 17 months for Group B (P<0.05). In Group B, optimal cytoreduction at delayed surgery was established in 14 (56%) patients. In Group B, median survival was 28 months in patients who were optimally cytoreduced at delayed surgery compared to 8 months for patients remaining with >1 cm residual tumor(p<0.0005). Conclusions: A pre-treatment diagnostic procedure was a poor predictor for optimal cytoreduction. Survival rates were better in Group A, however patients in Group B who were optimally cytoreduced at delayed surgery had similar survival rates compared to those undergoing upfront surgery. Neoadjuvant chemotherapy may exclusively be reserved for a specific subset of patients with advanced ovarian cancer. O-GOC RADICAL VAGINAL TRACHELECTOMY VS RADICAL HYSTERECTOMY FOR SMALL EARLY STAGE CERVICAL CANCER: A MATCHED CASE-CONTROL STUDY M. Beiner Sunnybrook & Women s College Health Sciences Centre - University of Toronto, Division of Gynecologic Oncology, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada J. Hauspy, B. Rosen, J. Murphy, S. Laframboise, S. Nofech-Mozes, N. Ismiil, G. Rasty, M. Khalifa, A. Covens Objectives: To determine the outcome from radical vaginal trachelectomy (RVT) compared to a matched group of patients undergoing radical hysterectomy for small early stage cervical cancer. Study Methods: All patient data was entered prospectively. Patients wishing preservation of fertility with cervical cancer, tumor <2 cm, and not meeting the definition of microinvasive cancer, were offered RVT. The outcomes were compared to a matched group of patients that underwent radical hysterectomy for stage IA/IB cervical cancer. Groups were matched 1:1 for age (±5 years), tumor size (±1 mm), histology, grade, depth of invasion (±1 mm), presence of capillary-lymphatic space invasion, pelvic lymph node metastasis, and adjuvant radiotherapy. Results: 137 patients underwent RVT from 1994 to patients were successfully matched. Median tumor size was microscopic. 43% and 49% were squamous and adeno/adenosquamous histology. Median depth of invasion was 3.1 mm. Capillary-lymphatic space invasion was present in 68% of cases. After a median follow-up of 51 and 58 months, 5 and 1 recurrences were diagnosed in the RVT and radical hysterectomy groups, respectively. 5-year recurrence free survival rates were 95% and 100%, respectively (p=0.17). 3 and 1 deaths occurred in the RVT and radical hysterectomy groups, resulting in 5-year survival rates of 99% and 100%, respectively (p=0.55). Conclusions: RVT seems to be the procedure of choice for women with small early stage cervical cancers wishing to preserve fertility. O-GOC CERVICAL INTRAEPITHELIAL NEOPLASIA: RECURRENCE AFTER TREATMENT LONGTERM FOLLOW-UP FROM THE BRITISH COLUMBIA COHORT STUDY T. Ehlen British Columbia Cancer Agency, Gynecology Oncology, 12th Street, Vancouver, BC, Canada J. Melnikow, C. McGahan, G. Sawaya, C. Andy Objectives: Assess the risk of recurrence of CIN2+ and of development of invasive cancer in women treated for CIN. Study Methods: A retrospective cohort of 37,142 women treated for CIN 1,2, or 3 from was identified from the Cytology database of the BCCA. Records were linked with the cancer registry and vital statistics. Women were followed over time until December 31, A low risk comparison group of 71,213 women with three negative smears and no history of CIN were identified and followed over the same time period. Logistic and Poisson regression analyses were used to examine the relationships of initial diagnosis, age, and treatment type to recurrence of CIN 2+ and incidence of invasive cancers. Results: CIN2+ recurrence rates dropped within six years below comparison group rates for women aged <30. CIN2+ rates over six years were 14.0% for women originally treated for CIN 3, 9.3% for CIN 2, and 5.6% for CIN 1. Initial diagnosis, age, and treatment type were all significantly associated with recurrence rates in the first 6 years. Odds for recurrence (cryotherapy=1) were Cone Biopsy=0.23 ( ); LEEP=0.31( ) and Laser=0.47( ); for women <30 years=1.14 ( ). Rates of invasive cancer were higher for the treatment group over the entire follow-up period. Conclusions: The post-treatment risk of CIN2+ is influenced by initial CINgrade, treatment-type, and age. Invasive cancer risk remains higher over an extended time period. O-GOC EVALUATION OF TWO MANAGEMENT STRATEGIES FOR PREOPERATIVE GRADE 1 ENDOMETRIAL CANCER M. Bernardini University of Toronto, Department of Gynecologic Oncology, 92 College Street, Toronto, ON, M5G 1L4, Canada T. May, M. Khalifa, S. Nofech-Mozes, A. Berchuck, A. Covens, L. Havrilesky Objectives: To assess the management and outcome of preoperative grade 1 endometrial cancer at two North American cancer centers. Study Methods: A retrospective analysis of 478 patients with preoperative centrally reviewed grade 1 endometrial cancer was performed. Data was collected from 2 academic centers, with 205 patients from center A and 273 from center B. In general, center A patients were not surgically staged. In contrast, center B patients usually underwent surgical staging unless intraoperative frozen section revealed grade 1 disease with minimal or no myometrial invasion. Results: The patients from the 2 centers were similar in terms of final grade and depth of myometrial invasion. Selective lymphadenectomy occurred in 15% of cases at center A and 50% at center B. 8 patients had positive lymph nodes, 4 from center A (2.0%), and 4 from center B (1.5%). Adjuvant radiation was given more frequently at centre A irrespective of surgical staging. The overall recurrence rate for the study population was 24/469 (5.1%). After a median follow-up of 33 months, there were no differences in disease specific survival (96.5% vs. 97.4%) or overall survival (94.9% vs. 93.8%) between centers. MAY JOGC MAI 2008 S57

3 Conclusions: Patients presenting with preoperatively reviewed/confirmed grade 1 endometrial cancer have a very favorable prognosis. Despite different treatment strategies due to patient characteristics, management philosophies, and resource issues, disease specific and overall survival between the groups is the same. O-GOC UTILIZATION OF PREOPERATIVE IMAGING AMONG UTERINE CANCER PATIENTS IN ONTARIO L. Gien Sunnybrook & Women s College Health Sciences Centre - University of Toronto, Division of Gynecologic Oncology, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada L. Barbera, R. Kupets, R. Saskin, L. Paszat Objectives: Improvement in imaging technology over time has lead to increasingly widespread use in health care, even when the imaging may not be indicated. This study evaluates patterns of preoperative CT and MRI use among uterine cancer patients in Ontario. Study Methods: This population study identified women diagnosed with uterine malignancy from in the Ontario Cancer Registry. Record linkages were made to other healthcare databases to characterize residence, socioeconomic status, comorbidities, and timing of investigations surrounding diagnosis. Results: women with surgery for uterine adenocarcinoma or sarcoma were identified, of which 1148 (9.2%) had a preoperative CT and/or MRI. Over ten years, the rate of CT use increased 4.5-fold while MRI use increased 10.6-fold. There were no significant differences in CT/MRI use among patients with increased comorbidities, urban residence or socioeconomic status. Higher rates of CT/MRI use were associated with non-endometrioid high-risk histology (33.5% vs 14.6%, p<0.0001). Time from diagnosis to surgery was 2 weeks longer if a preoperative CT/MRI was done. Half of these tests were ordered by non-gynecologists. Conclusions: The rate of preoperative CT and MRI use in patients with uterine cancer has increased twice as much as the rate in cancer patients overall. Given the questionable utility of preoperative CT/MRI in this disease, guidelines should be developed for use of these imaging tests in uterine cancer, especially when use is associated with a delay in surgery. O-GOC A COMPARISON OF OUTCOMES BETWEEN ENDOMETRIOID AND SEROUS CARCINOMAS OF THE OVARY: ARE THEY DIFFERENT CANCERS? L. Gien Princess Margaret Hospital, Division of Gynecologic Oncology, 610 University Avenue, Toronto, ON, M5G 2M9, Canada B. Rosen, T. Panzarella, W. Chapman, J. Dodge Objectives: Previous studies of endometrioid ovarian tumors have predominantly been small case series. This study compares overall survival (OS) and disease-free survival (DFS) between patients with endometrioid and serous ovarian carcinomas. Study Methods: A cohort of 588 cases was identified in a hospital database from ; 533 cases were eligible for analysis (98 endometrioid, 435 serous). Medical records were retrospectively reviewed, as were death data from the provincial cancer registry. The effect of histological subtype on OS and DFS were analyzed using Cox proportional hazard modeling. Results: Patients with endometrioid tumours were younger (51.9 vs 58.5, p<0.001), presenting with earlier stage (stage I 60.2% vs 6.0%, p<0.0001), and lower grade disease (grade % vs 3.8%, p<0.0001). Median follow-up was 4.3 years (endometrioid) and 2.3 years (serous), respectively. On univariate analysis, endometrioid histology was a significant favourable prognostic factor for 5-yr OS (82% vs 41%, p<0.0001) and DFS (70% vs 19%, p<0.0001). Adjusting for age, grade, primary cytoreductive surgery, year of diagnosis, and adjuvant treatment, endometrioid histology remained a significant independent predictor of favourable OS (HR 2.29, 95% CI , p=0.004) and DFS (HR 2.58, 95% CI , p<0.0001). However, when also adjusting for stage, histology was no longer an independent prognostic factor. Conclusions: According to this large cohort study, the significant survival differences between patients with endometrioid and serous ovarian carcinoma largely reflect differing stage of disease at presentation. O-GOC PREVIOUS HUMAN PAPILLOMAVIRUS (HPV) RELATED GYNECOLOGICAL NEOPLASIA IN WOMEN DIAGNOSED WITH ANAL CANCER IN THE PROVINCE OF ONTARIO W. Jiménez University of Toronto Department of Gynecologic Oncology, 92 College Street, Toronto, ON, M5G 1L4, Canada L. Paszat, R. Kupets, J. Tinmouth Objectives: To determine whether women diagnosed with anal cancer are more likely to have a history of HPV related gynecological cancer as compared to a matched control group. Study Methods: We performed a population-based, case-control study at the Institute for Clinical Evaluative Sciences (ICES).Cases were all women diagnosed with squamous cell anal cancer between 1992 and Up to 5 controls were selected for each case. Controls were matched for sex, age, socioeconomic status, area where they lived and number of years with information in our database. The exposure of interest was previous HPV-related gynecologic cancer, including cervical cancer, vulvar cancer and vaginal cancer. Conditional logistic-regression was performed. Results: A total of 674 women with anal cancer were identified with a median age of 61. Among the cases, 7 cervical, 3 vulvar and 1 vaginal cancers were identified compared with 5 cervical, 0 vulvar and vaginal cancers among the 3264 women in the control group. Previous HPV-related gynecological cancers (cervical, vaginal or vulvar cancer) was significantly associated with anal cancer (OR 10.5, 95% CI ). The median time between gynaecological and anal cancer diagnoses were 20 years for cervical cancer, 12 years for vaginal cancer and 5.7 years for vulvar cancer. Conclusions: Previous HPV-related gynecological cancers are strongly associated with anal cancer. Gynecologic cancers may occur decades before the anal cancer. O-GOC-JM ASSESSMENT OF OUTCOMES IN STAGE I/II HIGH RISK ENDOMETRIAL ADENOCARCINOMA PATIENTS TREATED WITH POSTOPERATIVE VAGINAL VAULT RADIOTHERAPY ONLY L. Eiriksson University of Alberta, Department of Obstetrics & Gynaecology, Room 201, Community Services Center, Royal Alexandra Hospital, Kingsway Ave, Edmonton, AB, T6A 4A4, Canada H. Steed, J. Cuartero, V. Capstick, A. Schepansky, R. Pearcey, W. Faught G. Dundas Objectives: At our centre, women with grade 3 endometrial adenocarcinoma undergo total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic node dissection (TAH BSO PLND). Surgically staged I/II, with high grade pathology and no evidence of pelvic lymph node metastases receive post-operative intracavitary brachytherapy only. The objective of this study is to S58 MAY JOGC MAI 2008

4 examine the recurrence rates and outcomes of this treatment strategy. Study Methods: A retrospective chart review was performed with ethics approval. One hundred and fifty-three patients were identified with grade 3 histology. Patients were excluded due to inadequate staging (n=70), incomplete follow-up (n=2), pelvic radiotherapy (n=14), or no adjuvant therapy (n=6). Sixty-one patients with surgical stage I/II endometrial adenocarcinoma, treated with vaginal vault brachytherapy only, between 1995 and 2004, were included. Results: The average age was 61, and 75% were postmenopausal. Average BMI was 30. Eleven percent were stage IA, 59% IB, 25% IC and 5% stage II. There were 8 recurrences (13.1%), of which three (4.9%) were local. The average time to recurrence was 25.9 months. The 5-year recurrence risk was 13.2% and 5-year survival probability 86.7%. The median progression-free survival was 95.7 months (95% CI ). Conclusions: Women with surgical stage I/II, high grade endometrial adenocarcinoma may receive adjuvant treatment with vaginal vault brachytherapy alone with acceptable recurrence rates and survival probabilities. O-GOC-JM THE GENETIC PROFILE OF OVARIAN LOW GRADE SEROUS CARCINOMA IS SIMILAR TO SEROUS LOW MALIGNANT POTENTIAL TUMORS WITH MICROPAPILLARY FEATURES AND DISTINCT FROM HIGH GRADE SEROUS CARCINOMA T. May University of Toronto, Department of Obstetrics and Gynecology, 92 College Street, Toronto, ON, M5G 1L4, Canada A. Tone, C. Virtanen, M. Sharma, H. Begley, I. Jurisica, B. Rosen, J. Murphy, P. Shaw, T. Brown Objectives: Low-Grade-Serous-Carcinoma (LGSC) is a chemoresistant neoplasm linked to Low-Malignant-Potentialtumors (LMP) and distinct from High-Grade-Serous-Carcinoma (HGSC) of the ovary. Micropapillary-features within LMP (LMP-MP) may increase the risk of malignant transformation. Study Methods: Laser-Capture-Microdissection was used to isolate epithelial cells from snap-frozen LMP (n=18), LMP-MP (n=9), LGSC (n=11), and HGSC (n=13). RNA was extracted, amplified, reverse transcribed to cdna and hybridized to Affymetrix-U133-Plus-2-genechip-arrays. Expression data were analyzed using GeneSpring and Significant-Analysis-of-Microarray (SAM). Differentially expressed genes were mapped to a protein-interaction-database (I2D) to prioritize genes for validation studies. Results: Unsupervised hierarchical clustering revealed collective clustering of LMP-MP and LGSC, separate from LMP and HGSC. SAM analysis identified 45 probe sets (representing genes) as differentially expressed between LMP and LMP-MP [FDR 2%] and 135 probes between LMP and LGSC [FDR 2%]. No differential gene expression was detected between LMP-MP and LGSC [FDR<88%]. I2D analysis highlighted gene members of the EGFR and MAPK1/3 pathways as differentially regulated between LMP and LGSC and 8 key genes were successfully validated using real-time-pcr. Conclusions: Our data demonstrate that LGSC has a genetic profile that is similar to LMP-MP and separate from LMP and HGSC. Furthermore, members of the MAPK1/3 and EGFR pathways appear to play a key role in low-grade serous carcinogenesis. Identification of novel genes associated with carcinogenesis and malignant transformation may lead to development of more effective targeted therapy for LGSC. O-GOC-MD OUTCOME OF 87 PREGNANCIES FOLLOWING RADICAL TRACHELECTOMY FOR THE TREATMENT OF EARLY-STAGE CERVICAL CANCER M. Plante Hôpital l Hôtel-Dieu de Québec, Obstetrics and Gynecology-Laval University, Québec, QC, Canada M. Renaud, J. Grégoire, M. Roy Objectives: To review the obstetrical results following vaginal radical trachelectomy (VRT). Study Methods: Retrospective review of our first 115 patients treated by a laparoscopic pelvic lymphadenectomy followed by a vaginal radical trachelectomy from October 1991 to January 2008 with regards to reproductive outcome. Results: Patients median age was 32 (21 42) and 86 (75%) were nulligravida. Four patients have recurred (3.5%) and 2 have died (1.8%). A total of 87 pregnancies occurred in 51 women. The majority (61%) had only one pregnancy, 18% had 2 and 21% had 3 or 4 pregnancies. Seventeen patients (21%) had a first trimester miscarriage, 3 (4%) had a second trimester miscarriage, 4 (5%) had pregnancy termination and 5 (6%) are currently pregnant. Fifty-eight pregnancies (66%) reached the third trimester: 3 women (5%) delivered at <32 weeks gestation, 8 (14%) between 32 and 36.6 weeks, including a twin gestation delivered for IUGR and 47 (81%) delivered beyond 37 weeks of gestation. Thirteen patients had infertility problems but 10 (77%) successfully conceived. One patient who had received adjuvant radiation therapy conceived following estrogen stimulation and embryo transfer. Three patients have received neoadjuvant chemotherapy (NACT) followed by VRT: one delivered at term twice, the second one is currently pregnant and the third one is unable to conceive (ovarian failure). Conclusions: The obstetrical outcome following radical trachelectomy is excellent. Fertility appears to be well preserved following NACT. O-GOC-MD ADJUVANT THERAPY IN GRANULOSA CELL TUMORS OF THE OVARY J. Hauspy Juravinski Cancer Centre, Gynecologic Oncology, 699 Concession Street, Hamilton, ON, L8V 5C2, Canada M. Beiner, I. Harley, A. Oza, B. Rosen, W. Chapman, L. Le, W. Levin Objectives: To retrospectively review the outcome and recurrence patterns of Granulosa Cell Tumors (GCT). Study Methods: All patients with GCT referred to the University Health Network, ( ) were reviewed retrospectively. 103 patients with histologically confirmed GCT form the basis of this study. Patient, tumor and treatment factors were assessed with multivariate analysis, using disease free survival (DFS) and overall survival (OS) as endpoints. Results: Presenting symptoms included vaginal bleeding (46%), amenorrhea (10%), pain (42%), abdominal distention (26%) and hirsutism (3%). Concurrent endometrial hyperplasia and endometrial cancer were diagnosed in 22 and 17% respectively. The mean duration of follow up was 100 months (7 399 months). Age, stage, tumor size, intra operative rupture and concurrent endometrial cancer were no significant risk factors for DFS nor OS. Overall, thirty six patients recurred and 12 patients died. The median DFS was 251 months for patients receiving adjuvant radiation compared with 114 months for patients without adjuvant radiation (p=0.02). On the multivariate analysis, adjuvant radiation remained a significant prognostic factor for DFS (p=0.04), but not for OS. Fifteen patients received chemotherapy; 13 (87%) for recurrence, 2 (13%) as adjuvant therapy. MAY JOGC MAI 2008 S59

5 Conclusions: Ovarian GCTs can be indolent tumors with long term survival. In our series, adjuvant radiation resulted in a significantly longer DFS. Randomized trials with long term follow-up are needed to define the role of adjuvant therapy in ovarian GCTs. O-GOC-MD PATTERNS OF SURGICAL CARE FOR UTERINE CANCER IN ONTARIO L. Elit McMaster University, Obstetrics and Gynecology, 1280 Main Street West, Hamilton, ON, L8V 5C2, Canada S. Schultz, R. Przybysz, J. Kwon, R. Saskin, N. Gunraj, D. Wilton, M. Simunovic, D. Urbach Objectives: To facilitate the planning of future resources for cancer services in Ontario, Cancer Care Ontario commissioned an evaluation of operative services for selected cancers. The affected population was characterized in terms of age, location of residence, and SES. Operative care was described in terms of inpatient verses outpatient access, LHIN of treatment, surgical specialist providing treatment, and specific procedures. The investigations and consults around the time of diagnosis were characterized. Study Methods: Women with an incident diagnosis of an uterine malignancy were identified from April 1, 2003, to March 31, 2004, using the Ontario Cancer Registry. Record linkages were created to other provincial health databases (i.e. Ontario Health Insurance Plan). Results: 1436 women had uterine cancer. Disease specific rates of cancer were higher in older women. 94.7% were treated surgically. Preoperative assessment included a CXR (100%), pelvic U/S (100%) and biopsy (85%). In 29% of women, an outpatient operative procedure (ie., D+C) is used to make the diagnosis. The most common definitive surgical procedure is a TAH+BSO. Rates of lymphadenectomy were 15.2% for pelvic and 0.9% for para-aortic. Gynecologists conducted 2/3s of the surgeries. Gynecologic oncologists did lymphadenectomies in half the patients they operated on. Conclusions: Surgery for uterine cancer is the most common gynecologic cancer procedure in Ontario. A significant number of women still receive an operative outpatient procedure to make the diagnosis. Lymphadenectomy rates are low even among gynecologic oncologists. S60 MAY JOGC MAI 2008