Volume 93  Number 3S  Supplement 2015

2.4) remained significant prognostic factors. Patients with 3 of these

factors present with a 3-year metastases-free interval of 52%
compared to 81% in patients with <3 factors (P  .001).
Conclusion: The distribution of distant metastases with comparable
numbers for nodal and organ sites and the identification of prognostic
factors allows for a better understanding of the course of distant
metastases in LACC. This information provides the basis for adapting
treatment strategies to minimize distant metastases, that is, for
designing future trials aiming at better control of nodal and organ
metastases.
Author Disclosure: I. Fortin: None. I. Jurgenliemk-Schulz: None. U.M.
Mahantshetty: None. C. Haie-Meder: None. P. Hoskin: None. B.
Segedin: None. C. Kirisits: None. K. Tanderup: None. J. Lindegaard:
None. K. Kirchheiner: None. R. Potter: None.

19
Salvage Versus Adjuvant Radiation Treatment for Women With
Early-Stage Endometrial Carcinoma: A Matched Analysis
S. Vance, C. Burmeister, N. Rasool, T. Buekers, and M.A. Elshaikh; Henry
Ford Health System, Detroit, MI
Purpose/Objective(s): Adjuvant radiation treatment (ART) has been
shown to reduce locoregional recurrences in early-stage endometrial
cancer (EC), but this has not translated into improved overall survival
benefit. As a result, some physicians forgo ART in these women, citing
successful salvage rates in cases of recurrence. We performed a
matched case analysis comparing survival endpoints in women treated
with salvage radiation treatment (SRT) for locoregional recurrence of
initially International Federation of Gynecology and Obstetrics (FIGO)
stage IeII EC relative to similarly matched women treated upfront
with ART.
Materials/Methods: We identified 40 consecutive patients with stage IeII
Type 1 EC who underwent hysterectomy and received no ART
between January 1989 and December 2013 but later developed
locoregional recurrence and subsequently received SRT. An additional 374
patients underwent hysterectomy followed by ART over the same period.
Patients in the SRT group were matched to the ART group based on
FIGO stage and tumor grade in a 1:3 ratio. Disease-specific survival (DSS)
and overall survival (OS) were calculated using the Kaplan-Meier
method from date of hysterectomy to the time of death. Cox regression
modeling was used to explore the effect of various factors on the survival
endpoints.
Results: A total of 156 women were matched (39:117). Median
follow-up was 56 months. The groups were balanced with the
following exceptions: the SRT group had (1) shorter median followup, (2) fewer patients with peritoneal cytology examination, and (3)
fewer dissected lymph nodes. Recurrences in the SRT group were
more commonly isolated to the vagina (74.3% vs 28.6%, P Z .01).
More SRT patients received a combination of pelvic external beam
RT with vaginal brachytherapy (94.8% vs 35%, P < .001) and as a
result, higher equivalent RT doses (EQD2) were used in the SRT
patients (median EQD2 94.3 Gy vs 54.7 Gy, P Z .02). The ART
group had significantly better 5-year DSS (95% vs 77%, P < .001)
and 5-year OS (79% vs 72%, P Z .005) compared with the SRT
group.
Conclusion: Our study suggests that women who receive SRT for their
locoregional recurrence have worse disease-specific and overall survival
compared to those matched patients who received ART. Further studies are
warranted to develop a high-quality cost-effectiveness analysis as well as
accurate predictive models for tumor recurrence. Until then, ART should at
least be considered in the management of early-stage EC patients with
adverse prognostic factors.
Author Disclosure: S. Vance: None. C. Burmeister: None. N. Rasool:
None. T. Buekers: None. M.A. Elshaikh: None.

Oral Scientific Sessions

S9

20
Assessment of Parametrial Response by Growth Pattern in Patients
With FIGO Stage IIB and IIIB Cervical Cancer: Analysis of Patients
From a Prospective Multicentric Trial (EMBRACE)
K. Yoshida,1 N. Jastaniyah,2 A.E. Sturdza,3 J. Lindegaard,4 B. Segedin,5
U.M. Mahantshetty,6 F. Patel,7 I. Jurgenliemk-Schulz,8 C. Haie-Meder,9
R. Sasaki,1 and R. Potter10; 1Kobe University Graduate School of
Medicine, Kobe, Japan, 2King Faisal Specialist Hospital and Research
Center, Medical University of Vienna, Riyadh, Saudi Arabia, 3Medical
University of Vienna, Vienna, Australia, 4Aarhus University Hospital,
Aarhus, Denmark, 5Institute of Oncology Ljubljana, Ljublijana, Slovenia,
6
Tata Memorial Centre, Parel, Mumbai, India, 7Post Graduate Institute of
Medical Education and Research, Chandigarh, India, 8University Medical
Center, Utrecht, Netherlands, 9Institut Gustave Roussy, Paris, France,
10
Medical University of Vienna, Vienna, Austria
Purpose/Objective(s): Considerable reduction in tumor volume during
external beam radiation therapy (EBRT) is a prominent feature of cervical
cancer treatment. Defining and quantifying residual disease at the time of
brachytherapy (BT) is a prerequisite for image guided adaptive BT
(IGABT). Tumor morphology subtype in cervical cancer, ranging from
expansive to infiltrative, is considered to correlate with treatment response.
The purpose of this study is to assess disease response along the
parametrial space according to tumor morphology in patients with
International Federation of Gynecology and Obstetrics (FIGO) stage IIB
and IIIB cervical cancer at the time of IGABT using the database of a large
prospective multicentric trial, an international study on magnetic
resonance imaging (MRI)-guided BT in locally advanced cervical cancer
(EMBRACE).
Materials/Methods: Patients with FIGO stage IIB and IIIB cervical
cancer registered as of November 2013 in the EMBRACE study were
evaluated. Tumors were stratified according to morphologic subtype
(expansive and infiltrative) on MRI at diagnosis and the characteristics
of those subtypes were analyzed. Parametrial involvement at diagnosis
and at BT was evaluated and the response to EBRT and chemotherapy
(CRT) was classified as good, moderate, or poor. The response
grade was compared between the 2 groups. Then, tumor volumes and
dosimetric parameters at diagnosis and at BT were analyzed and
compared.
Results: A total of 452 patients were evaluated, of which 186 had
expansive growth type and 266 had infiltrative morphology. Patients with
infiltrative tumors had more extensive disease as indicated by higher rate
of FIGO stage IIIB disease as well as radiological evidence of extension
into the distal parametrial space and to pelvic sidewall on MRI. Cervical
necrosis was more common in the infiltrative group. Good response was
more common in the expansive group (34% vs 24%) and poor
response was more common in the infiltrative group (11% and
18%). Significant difference in response was observed between 2 groups
(P Z .01). Mean gross tumor volume at diagnosis (GTVD) was equal in
both groups (51.7 cm3). The high-risk clinical target volume (CTVHR) was
larger in infiltrative groups (37.9 cm3 vs. 33.3 cm3, P Z .005). The
mean CTVHR D90was higher in expansive group (92.7 Gy and 89.4 Gy, P
< .001). Interstitial needles were used more in the infiltrative group (39%
vs 54%, P Z .002).
Conclusion: Infiltrative tumors are more advanced at presentation and
respond less favorably to CRT when compared to expansive tumors. Both
are comparable in size at diagnosis. Therefore, CTVHR becomes larger and
CTVHR D90 smaller in infiltrative tumors. However, more frequent use of
interstitial needles allows to compensate and to achieve high doses, also in
infiltrative tumors. Outcomes for Stage IIB and IIIB cervical cancer
treated with IGABT according to tumor morphologic subtype need to be
analyzed.
Author Disclosure: K. Yoshida: None. N. Jastaniyah: None. A.E.
Sturdza: None. J. Lindegaard: None. B. Segedin: None. U.M.
Mahantshetty: None. F. Patel: None. I. Jurgenliemk-Schulz: None. C.
Haie-Meder: None. R. Sasaki: None. R. Potter: None.