Volume 84 � Number 3S � Supplement 2012 Poster Viewing Abstracts S447

Purpose/Objective(s): Some unusual cases of patients with cervical

cancer in which an elevation of SCC-Ag was not observed at diagnosis

but was observed on recurrence or at vice versa. Objective of this study

was to identify clinicopathologic factors associated with this unusual

SCC-Ag and to determine whether SCC-Ag is a useful tumor marker in

such patients.

Materials/Methods: 6We retrospectively reviewed 1610 patients with

biopsy-confirmed cervical cancer. Among 129 patients with recurrence, 14

who showed a normal SCC-Ag level at diagnosis but an elevated level at

recurrence were classified as group I; 22 patients with an elevated SCC-Ag

level at diagnosis but not at recurrence were classified as group II; and 76

patients with an elevated SCC-Ag level at both diagnosis and recurrence

were classified as group III.

Results: Regarding pathological characteristics of patients in groups I,

II, and III, 8 (57.10%), 19 (86.4%), and 72 (94.7%), respectively, had

squamous cell carcinoma; five (35.7%), one (4.5%), and two (2.6%) had

adenocarcinoma; and one (7.1%), one (4.5%), and two (2.6%) had

adenosquamous cell carcinoma. The initial level of SCC-Ag showed

a range of 0.2-1.4 ng/ml (median: 1.0 ng/ml), 1.5-21.0 ng/ml (median:

2.8 ng/ml), and 1.5-362.0 ng/ml (median: 8.4 ng/ml), respectively. The

five-year disease-free survival of groups I, II, and III was 71.0, 91.0,

and 21.1% (p Z 0.418), and the five-year overall survival was 34.3,

58.4, and 33.3% (p Z 0.142), respectively. The number of patients with

SCC-Ag level exceeding 1.5 ng/ml at diagnosis increased with stage.

With respect to response to treatment, nine patients (64.3%) in group I,

15 (68.2%) in group II, and 51 (67.1%) in group III showed complete

response; two (14.3%), three (13.6%), and 19 patients (25.0%) showed

partial response; two (14.3%), two (9.1%), and one (1.3%) showed

progression of disease. Seven (50.0%), 16 (72.7%), and 62 patients

(81.6%) in groups I, II, and III, respectively, showed a positive

biochemical response.

Conclusion: We assume that the lack of elevation of SCC-Ag at diagnosis

or relapse is due to lack of cells that produce SCC-Ag. Based on our

results, we came to a conclusion that in group I, the initial production of

SCC-Ag was not high enough to detect because of the low number of cells

producing SCC-Ag; however, SCC-Ag elevation was detected after relapse

due to the high number of SCC-Ag-producing cells in the recurred lesion.

In group II, the primary lesion contained cells that produced SCC-A.

However, these cells were no longer present after treatment, so there were

no cells capable of producing SCC-Ag at relapse and therefore no eleva-

tion of SCC-Ag.

Author Disclosure: B. Jeong: None. D. Choi: None. S. Huh: None. W.

Park: None. D. Bae: None. B. Kim: None.

2607Combined Chemotherapy and Radiation (RT) Improves Survival forNode-Positive, High Grade Endometrial CancerL.J. Lee and A.N. Viswanathan; Brigham and Women’s Hospital, Boston,

MA

Purpose/Objective(s): To evaluate clinical outcome and patterns of

disease recurrence by adjuvant therapy type for women with node-positive,

high grade adenocarcinoma of the uterus.

Materials/Methods: Database review identified 73 patients (pts) with

FIGO Stage IIIC grade 3 endometrial cancer diagnosed from 1995 to

2009. Study inclusion required TAH/BSO and negative chest imaging.

Histologic subtypes were: papillary serous (20, 27%), endometrioid (22,

30%), clear cell (9, 12%), mixed (21, 29%) and undifferentiated (1, 1%).

Lymph node assessment was sampling in 33 pts and dissection in 40,

including the paraortics (PAN) in 18. Adjuvant treatment was external

beam RT alone in 14 pts (19%), combined chemotherapy and RT in 56

(77%), chemotherapy alone in 1 (1%), and no adjuvant therapy in 2

(3%). RT type was pelvic in 32 (median 45 Gy), extended field (EFRT)

in 22 (45 Gy) and whole abdomen (WART) in 15 (30 Gy with EFRT

boost in 4). A vaginal brachytherapy boost was delivered in 51 pts.

Actuarial disease-free (DFS) and overall survival (OS) estimates were

calculated by Kaplan-Meier, and multivariate analysis (MVA) was

performed using Cox proportional hazards. Median follow-up time was

50 months.

Results: Median age at diagnosis was 67 years (range 28-87). Deep

myometrial invasion was present in 52 pts (71%) and positive cytology

in 20 (27%). Fifty-six pts (77%) had positive pelvic nodes only, 4 (5%)

had positive paraortic nodes only and 13 (18%) had both. The median

number of recovered nodes was 10 and positive nodes 1. By RT type,

the most common sites of relapse were paraortic for pelvic RT (nZ5,

16%), peritoneum for EFRT (nZ5, 23%) and distant for WART (nZ6,

40%). All 3 pts who did not receive RT had pelvic and/or paraortic

relapse. Intraperitoneal relapse was more common in pts with positive

cytology (30% vs. 8%, pZ0.02) and non-endometrioid histology (20%

vs. 0%, pZ0.01), but not differ significantly by RT type (pZ0.2). DFS

and OS rates at 5 years were 44% and 53%, respectively. By histologic

subtype, 5-year DFS and OS rates were 24% and 28% for serous, 62%

and 85% for grade 3 endometrioid, 22% and 17% for clear cell and

50% and 51% for mixed histology (pZ0.09 and p<0.001). Deep

myometrial invasion, number of positive lymph nodes and RT type were

not associated with outcome. On MVA adjusted for subtype, combined

modality therapy significantly improved DFS (HR 0.21, 95% CI 0.10-

0.44, p<0.01) and OS (HR 0.27, 95% CI 0.13-0.58, p<0.01) compared

to adjuvant RT alone.

Conclusions: Combined modality therapy decreased recurrence and

improved survival in pts with node-positive, high grade endometrial

cancer. Endometrioid and mixed subtypes had significantly better

outcomes compared to serous and clear cell cancers. Future studies are

needed to define the optimal chemotherapy regimen, sequencing, and

radiation fields.

Author Disclosure: L.J. Lee: None. A.N. Viswanathan: None.

2608WITHDRAWN

2609Adjuvant Carboplatin/Paclitaxel and Vaginal Brachytherapy forLocally Advanced Endometrial CancerM. Young, S.A. Higgins, E. Ratner, S. Mani, S.B. Evans, D. Silasi,

M. Azodi, T. Rutherford, P. Schwartz, and S. Damast; Yale University

School of Medicine, New Haven, CT

Purpose/Objective(s): To report a single institution experience utilizing

adjuvant carboplatin/paclitaxel (C/T) chemotherapy and vaginal brachy-

therapy (VB) without external beam radiation therapy (EBRT) for locally

advanced endometrial cancer (EC).

Materials/Methods: From 2004-2010, 80 women with locally advanced

endometrial adenocarcinoma were treated with comprehensive surgical

staging, followed by concurrent carboplatin (AUC Z 5) and paclitaxel

(175 mg/m2) chemotherapy given every 3 weeks for 6 planned cycles.

Two or 3 fractions of high dose rate VB using Ir-192 (7 Gy per frac-

tion, 0.5cm from cylinder surface) was planned within 6-8 weeks of

surgery. Locally advanced disease was defined as FIGO 2009 stage

IIIA-IIIC2 or stage I-II with positive cytology (FIGO 1988 Stage IIIA).

Patients with stage IV or sub-optimal surgical debulking were excluded.

For analysis, patients were grouped into Type 1 (FIGO grade 1-2

endometrioid histology, nZ40) or Type 2 (FIGO grade 3, clear cell,

papillary serous, or mixed histologies, nZ40). Kaplan-Meier methods

were used to estimate survival and log-rank was used for comparison

between groups.

Results: Mean age at diagnosis was 63 years (range 27-89). Surgery

was hysterectomy and bilateral salpingoophorectomy (70% open, 15%

laparoscopic, and 15% robotic), pelvic washings, omentectomy (36%),

pelvic lymph node dissection (97.5%, median 20, range 2-60), and

paraortic node sampling (85%, median 4, range 1-28). The pathologic

sub-stages according to Type 1/Type 2 histology were: IIIA (nZ8/

nZ13); IIIB (nZ0/nZ0); IIIC1 (nZ11/nZ13); IIIC2 (nZ9/nZ8);

stage I-II + positive cytology (nZ12/nZ6). Seventy seven (96.3%)

patients completed 6 cycles of C/T. VB total dose was 21 Gy, 14 Gy,