16th Biennial Meeting of the International

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16th Biennial Meeting of the International Gynecologic Cancer Society Lisbon, Portugal October 28-31, 2016

Volume 26, Supplement 3, October 2016

Copyright © 2016 by IGCS and ESGO. Unauthorized reproduction of this article is prohibited.

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IGCS-0887 PRESIDENTIAL ADDRESS, PLENARY ORALS AND BUSINESS MEETING Topotecan (T) ± Sorafenib (S) for platinum-resistant ovarian cancer (PROC): results of doubleblind placebo-controlled randomized NOGGO – AGO intergroup trial J. Sehouli1, S. Mahner2, T. Neunhoeffer3, P. Harter4, N. de Gregorio5, C. Fridrich6, S. Markmann7, R. Richter1, J. Potenberg8, R. Lorenz9, M. Schmidt10, G. Doering11, A. Belau12, H.J. Lueck13, R. Chekerov1, A. du Bois4, F. Hilpert14 1European Competence Center for Ovarian Cancer- Department of Gynaecology, Charité Campus Virchow, Berlin, Germany 2Department of Gynaecology and Obstetrics, Ludwig-Maximilians-University, Munich, Germany 3Department of Gynaecology, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany 4Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte, Essen, Germany 5Department of Obstrics and Gynaecology, Universtity of Ulm, Ulm, Germany 6Department of Gynaecology, Universitaetsklinikum Koeln- Klinik und Poliklinik, Koeln, Germany 7Department of Gynaecology, Klinikum Suedstadt, Rostock, Germany 8Department of Hematology, Waldkrankenhaus Spandau, Berlin, Germany 9Gynaecologic Oncology, Gemeinschaftspraxis Lorenz-Hecker-Wesche, Braunschweig, Germany 10Department of Obstrics and Gynaecology, Johannes Gutenberg University, Mainz, Germany 11Gynaecologic Oncology, Gemeinschaftspraxis Doering-Schreiber, Bremen, Germany 12Gynaecologic Oncology, Ernst Moritz Arndt Universität Greifswald - Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany 13Gynaecologic Oncology, Gyn Onko Hannover, Hannover, Germany 14Gynaecology, Gynaecologic Oncology Center at Jerusalem Hospital, Hamburg, Germany Background and Aims: Sorafenib(S), a multi TK-inhibitor was combined with topotecan (T), a topoisomerase inhibitor, in a 5day schedule of T and a sequential combination with S. Methods: Eligible pts with PROC (progression ≤ 6 mo after ≥ 4 platinum cycles) and ≤ 2 prior CT lines were randomized 1:1 to topotecan 1,25mg/m², d1-5, q21d with either placebo or sorafenib 2x400 mg/daily, d6-14 for 6 chemotherapy cycles, and maintenance sorafenib 2x400 mg/placebo daily for altogether 1 year. The number of treatment lines was stratified. The primary objective was PFS. Secondary endpoints include OAS, objective response, safety and PRO. Results: Inside the 172 eligible pts with median age 59 (25-79 years), 72 pts were in second and 100 in third line. 54.7% of the patients received 6 cycles chemotherapy. Addition of S to T induced no additional toxicity grade 3/4, but more hand-foot-skin reactions (13.3% vs. 0%; p 30 kg/m2 (p=0.04). Only 1 patient who had a false-negative result yielding 96.4% sensitivity (95% CI 79.8%-99.8%) and 99.3% negative predictive value (95% CI 95.6%-100%). Specificity was 100% (95% CI 96.7%-100%).

Conclusions: In this retrospective cohort of women with early stage cervical cancer who underwent sentinel lymph node biopsy followed by complete pelvic lymphadenectomy, we found very high sensitivity and negative predictive values for the technique. We believe it is time to change the standard of care to sentinel lymph node biopsy only for women with early-stage cervical cancer.



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IGCS-0187 PRESIDENTIAL ADDRESS, PLENARY ORALS AND BUSINESS MEETING DISEASE-FREE AND OVERALL-SURVIVAL AFTER TOTAL LAPAROSCOPY VERSUS OPEN ABDOMINAL HYSTERECTOMY FOR EARLY STAGE ENDOMETRIAL CANCER: RESULTS FROM THE LACE TRIAL A. Obermair1, V. Gebski2, L. Davies2, A. Brand3, R. Hogg3, T.W. Jobling4, R. Land5, T. Manolitsas4, M. Nascimento5, D. Neesham6, J.L. Nicklin5, M.K. Oehler7, G. Otton8, L. Perrin5, S. Salfinger9, I. Hammond10, Y. Leung11, P. Sykes12, H. Ngan13, A. Garrett5, P. Forder14, M. Laney12, T.Y. Ng13, K. Tam13, K. Chan13, D.H. Wrede6, S. Pather15, B. Simcock12, R. Farrell16, G. Robertson16, G. Walker6, A. McCartney10, M. Janda17 1University of Queensland, School of Medicine, Brisbane, Australia 2University of Sydney, NHMRC Clinical Trials Centre, Sydney, Australia 3Westmead Hospital, Department of Gynaecologic Oncology, Sydney, Australia 4Monash Medical Centre, Department of Gynaecologic Oncology, Melbourne, Australia 5Queensland Centre for Gynaecological Cancer, -, Brisbane, Australia 6Royal Women’s Hospital, Gynaecological Oncology, Melbourne, Australia 7Royal Adelaide Hospital, Department of Gynaecological Oncology, Adelaide, Australia 8John Hunter Hospital, Gynaecological Oncology, Newcastle, Australia 9King Edward Hospital, Gynaecological Oncology, Perth, Australia 10St John of God Hospital, Gynaecologic Oncology, Perth, Australia 11University of Western Australia, School of Women's and Infants' Health, Perth, Australia 12Christchurch Women's Hospital, Gynaecologic Oncology, Christchurch, New Zealand 13Queen Mary Hospital, Department of Obstetrics and Gynecology, Hong Kong, Hong Kong- China 14University of Newcastle, Faculty of Health and Medicine, Newcastle, Australia 15Royal Prince Alfred Hospital, Gynaecologic Oncology, Sydney, Australia 16Royal Hospital for Women, Gynaecological Oncology, Sydney, Australia 17Queensland University of Technology- Institute of Health and Biomedical Innovation, School of Public Health, Brisbane, Australia Background and Aims: The LACE trial aims to assess equivalence between Total Abdominal Hysterectomy (TAH) and Total Laparoscopic hysterectomy (TLH) in patients with apparent stage 1 endometrioid endometrial cancer in disease-free survival. Previously, the GOG-LAP2 trial failed to demonstrate non-inferiority of patients undergoing laparoscopic hysterectomy for uterine cancer. Methods: Between 2005-2010, 760 patients were enrolled in the multicentre, randomised clinical LACE trial, and 753 who completed at least 6 week’s assessment were followed for 4 years. Pelvic/aortic lymph node dissection was at the surgeons’ discretion. Presence of recurrent disease was proven by clinical assessment, radiological work-up ± histological confirmation. Sample size calculations for 90% power, at a 5% Type I error level, required 755 patients to declare non-inferiority with a margin of 7% or less at 4.5 years. Results: The median follow-up at study closure was 4.53 years; 404 patients were assigned to TLH and 349 to TAH; 126 (17%) relapses were recorded, 71 (17%) in the TLH group, and 55 (16%) in the TAH group



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(about half due to endometrial cancer, half due to other causes in both groups). Of all patients, 367 (48.0%) underwent lymph node dissection, 161 (40.0%) in the TLH and 206 (58.0%) in the TAH group (p4cm in 93 (14.9%) and 2b in 357 (57%) patients. Toxicity was reported according to the International Common Toxicity Criteria Results: No toxic deaths were reported. 198 serious adverse events (SAE’s) occurred: 145 in the NACT + surgery arm versus 53 in the standard CCRT arm. Within the group of SAE’s 109 serious adverse reactions (SAR’s) in arm 1, and 35 SAR’s in arm 2 were reported. Nearly all were chemotherapy related. Protocol treatment was discontinued in 41 patients due to toxicity (6.5%). In arm 1 in 23 patients surgery was abandoned due to NACT related toxicity. Most frequent reported were nausea and vomiting, infections, metabolism disturbance and renal and urinary disorders. Grade 3/4 complications related to surgery were found in the following number of patients: 8 (3.3%) bleeding, 10 (4.2%) operative lesions to ureter or bladder, 3 (1.2%) fistula, 7 (2.9%) others (sepsis, urinary tract infection and wound dehiscence).



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Conclusions: Overall toxicity was acceptable, occurred more frequently in the NACT + surgery arm and was mainly related to NACT.



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IGCS-0486 ORAL COMMUNICATION 2 LONG TERM ONCOLOGICAL OUTCOME AFTER CONVENTIONAL RADICAL HYSTERECTOMY VERSUS TWO NERVE-SPARING MODALITIES FOR EARLY STAGE CERVICAL CANCER M.D.J.M. van Gent1, J.C.B. van der Veer1, J.B.M.Z. Trimbos1, C.D. de Kroon1 1Leiden University Medical Center, Gynaecology, Leiden, Netherlands Background and Aims: Nerve-sparing radical hysterectomy was introduced to improve quality of life by reducing bladder, bowel and sexual dysfunction due to conventional radical hysterectomy (CRH) for early stage cervical cancer. The Leiden nerve-sparing radical hysterectomy (LNSRH) was first developed and later modified to the Swift-procedure by taking the morphogenetic unit into account. We aimed to analyse the local recurrence rate (LRR) and the 5-year disease-free survival (5yDFS) between the CRH and these two nerve-sparing techniques. Methods: A single centre, observational prospective cohort study comparing LRR and 5yDFS in women undergoing CRH (January 1994 - December 1998), LNSRH (January 2001 – January 2005) or Swift procedure (October 2006 - May 2010) for early stage cervical cancer. Results: 362 patients (124 CRH, 121 LNSRH, 117 Swift) were included. The cohorts did not differ with regard to tumour characteristics except for lymph-vascular space invasion (LVSI) (p=0.05) and FIGO-stage (p=0.04). LRR was 3.2%, 6.6% and 7.7% (NS, p=0.30) and 5yDFS was 81.5%, 71.1% and 82.9% (NS, p=0.06) respectively. In multivariate analyses type of surgery was not a prognostic factor for LRR nor 5yDFS (HR 1.9 (95%CI:0.58-6.46) and HR 2.41 (95% CI:0.73-7.94) and HR 1.47 (95%CI:0.86-2.51) and HR 0.91 (95%CI:0.49-1.69) LNRH and Swift respectively). Lymph node involvement, LVSI and tumour size > 40 mm however were prognostic factors for recurrence. Conclusions: There is no significant difference in LRR and 5yDFS in our three cohorts. Nerve sparing surgery for early stage cervical cancer is safe and should be offered to patients to improve quality of life after surgery.



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IGCS-0934 ORAL COMMUNICATION 2 PRELIMINARY RESULTS OF EORTC 55994 COMPARING NEOADJUVANT CHEMOTHERAPY FOLLOWED BY SURGERY WITH CHEMORADIATION FOR STAGE IB2-IIB CERVICAL CANCER G. Kenter1, I. van Luijk2, D. Katsaros3, S. Greggi4, F. Landoni5, P. Ottevanger6, J. Kobierski7, L. Massuger8, H. van Doorn9, N. Reed10, A. Casado Herraez11, E. De Maio12, C. Coens12, I. Vergote13 1VUMC, gynaecology, Amserdam, Netherlands 2MC Haaglanden Bronovo, the Hague, Netherlands 3Gynecologic Oncology Ospedale S.Anna and University of Turin, Turin, Italy 4Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy 5Instituto Europeo Oncologico Milano, Milan, Italy 6Radboud University Medical Center, Medical Oncology, Nijmegen, Netherlands 7Gdansk Medical University, Radiation Oncology, Gdansk, Poland 8Radboud University Medical Center, Nijmegen, Netherlands 9UMC Erasmus, Rotterdam, Netherlands 10Gartnavel General Hospital, Medical Oncology, Glasgow, United Kingdom 11Hospital Universidad San Carlos, medical oncology, madrid, Spain 12EORTC, headquarters, Brussels, Belgium 13UZ Gasthuisberg, Gynaecology,, Belgium Background and Aims: This trial in Stage IB2-IIB cervical carcinoma comparing platinum containing neoadjuvant chemotherapy (NACT), followed by radical hysterectomy (arm 1) with standard concomitant chemoradiotherapy (CCRT, arm 2) completed recruitment in June 2014. Awaiting final results in 2019, preliminary data on the surgical arm are presented here. Methods: 626 patients from 10 countries were randomized over 11 years: 314 to arm NACT, 312 to CCRT. 527 patients (84.2%) had squamous cell carcinoma, 93 (14.8%) adeno(squamous) carcinoma . FIGO stage was Ib2 in 168 (26.8%), 2a>4cm in 93 (14.9%) and 2b in 357 (57%) patients. Results: In NACT arm, 238 (76%) patients underwent surgery. Reasons for not having surgery after NACT were treatment-related toxicity in 23 patients (30.7%/7.3%), progressive disease in 17 patients (22.7%/5.4%) or insufficient response to chemotherapy in 14 patients (18.7/4.5%). During surgery pelvic regional lymph nodes were removed in 223 patients (93.7%) and in 198 patients (83.2%) also the common iliac nodes. Pathological examination showed: parametrial invasion in 49 (20.6%), vascular invasion in 57 (23.9%), positive surgical margins in 32 (13.4%), perinodal spread in 19 (8.0%), pelvic lymph node metastases in 66 (27.7%), metastatic common iliac lymph nodes in 22 (9.2%) and para-aortic nodes in 7 ( 2,6%) patients. Pathological complete response was found in 53 patients (22.3%).

Conclusions:



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This is the largest randomized trial in cervical cancer comparing NACT followed by radical hysterectomy directly with CCRT. These first data indicate that in the surgery arm short term toxicity due to NACT influenced further treatment.



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IGCS-0031 ORAL COMMUNICATION 2 From conventional radiocolloid plus blue dye to Indocyanine Green (ICG): an European multicenter comparison of methods towards the optimization in SN mapping of cervical cancer A. Buda1, A. Papadia2, I. Zapardiel3, E. Vizza4, F. Ghezzi5, T. Dell'Anna6, S. Imboden2, B.D. De la Noval3, G. Di Martino6, B. Bussi6, M. Muller2, C. Crivellaro7 1, Parabiago, Italy 2University of Berne- Berne- Switzerland, Department of Obstetrics and Gynecology University of Berne- Berne- Switzerland, Berne, Switzerland 3La Paz University Hospital - IdiPAZ, Gynaecologic Oncology Unit, Madrid, Spain 4Gynecologic Oncologic Unit "Regina Elena" National Cancer Institute, Department of Oncological Surgery, Rome, Italy 5University of Insubria- Del Ponte Hospital-, Department of Obstetrics and Gynecology, Varese, Italy 6San Gerardo Hospital- Unit of Gynecology Oncology Surgery, Department of Obstetrics and Gynecology, Monza, Italy 7University of Milano-Bicocca, Technomed Foundation- Nuclear Medicine, Monza, Italy Background and Aims: The aim of this retrospective study was to compare the detection rate (DR) and bilateral detection (BM) of sentinel lymph node (SLN) mapping in women with cervical cancer using Indocyanine Green (ICG) versus the standard TC99m radiotracer + Blue dye (BD). Methods: All consecutive women with cervical cancer stage 1A2-1B1 from five European institutions were reviewed. All centers used a laparoscopic approach with the same intracervical injection. SLNs were submitted for final pathology and ultrastaging were performed according to institutional protocol. DR and BM of ICG were compared with results obtained using TC99m + BD. Results: Among 144 patients included, 76/144 of women (53%) underwent preoperative SLN mapping with radiocolloid TC99m and intraoperative BD, whereas 68/144 (47%) patients were mapped using intraoperative injection of ICG. The detection rate of SLN mapping was 96% and 100% for TC99 m + BD and ICG, respectively. Bilateral mapping was achieved in 98.5% for ICG, and 76.3% in TC99 m + BD and this difference was statistically significant (p < .0001). One false negative SLN was recorded. Sensitivity, negative predictive value and the false negative rate were 96%, 99%, and 0.04%. Conclusions: In women with early stage cervical cancer, SLN mapping using ICG achieved a significant higher DR and BM when compared with standard radiocolloid and BD. In our opinion, SLN mapping with an intracervical injection of ICG is accurate, safe and reproducible in patients with 1A2-1B1 disease. The additional value of fluorescence SLN mapping on both perioperative morbidity and survival should be confirmed by the ongoing controlled trials.



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IGCS-0264 ORAL COMMUNICATION 2 Patient-reported Outcomes and toxicity at discontinuation of therapy in advanced or persistent cervical cancer: an analysis of GOG protocol 240 D. Chase1, H. Huang2, L. Ramondetta3, B. Monk4, R. Penson5, K. Gil6, L. Landrum7, M. Leitao8, A. Oaknin9, W. Huh10, H. Pulaski11, R. Katina12, S. Guntupalli13, D. Richardson14, R. Salani15, S. Ali16, K. Tewari17 1University of Arizona Cancer Center at St. Joseph's Hospital and Medical Center, Gynecologic Oncology, Phoenix, USA 2NRG Oncology, Statistics and Data Management Center, Buffalo, USA 3MD Anderson, Gynecologic Oncology, Houston, USA 4University of Arizona Cancer Center, Gynecologic Oncology, Phoenix, USA 5Massachusetts General Hospital, Gynecologic Oncology, Boston, USA 6Summa Health, Grant and Proposal Development, Akron, USA 7Oklahoma Univsersity Health Sciences Center, Gynecologic Oncology, Oklahoma CIty, USA 8Memorial Sloan Kettering Cancer Center, Gynecologic Oncology, New York, USA 9GEICO, Gynecologic Oncology, Barcelona, Spain 10University of Alabama, Gynecologic Oncology, Birmingham, USA 11University of Cinncinati, Gynecologic Oncology, Cinncinati, USA 12Womens and Infants Hospital, Gynecologic Oncology, Providence, USA 13University of Colorado, Gynecologic Oncology, Denver, USA 14UT Southwestern, Gynecologic Oncology, Dallas, USA 15Ohio State Universiity Medical Center, Gynecologic Oncology, Columbus, USA 16NRG Oncology, Statistis and Data management, Buffalo, USA 17University of California Irvine Medical Center, Gynecologic Oncology, Orange, USA Background and Aims: The primary objective of this study is to describe patient-reported outcomes (PRO) and toxicities at time of treatment discontinuation secondary to progression or toxicities on an advanced or recurrent cervical cancer clinical trial. Methods: This is a descriptive study of the toxicity grade and QOL score most proximate within one month of treatment discontinuation. Results: 303 patients discontinued protocol treatment (209 due to progression and 96 for toxicities). Median survival time from treatment discontinuation to death was 6.9 months (0.7-39.1) for those who progressed (N=193) versus 9.1 (1.1-56.5) for those who discontinued therapy due to toxicities (N=76). For those with toxicities, the majority of grade 3- 4 toxicities were hematologic, neurologic, gastrointestinal and pain. 184/303 completed QOL assessment within one month of treatment discontinuation. Those patients who discontinued treatment due to progression had a mean decline in the FACT-Cx TOI of 2.7 points (declines in physical well-being (PWB) and cervical cancer subscale). Mean emotional well-being and pain scores improved from baseline. A mean 10.3 point decline in FACT-Cx TOI was seen in patients who discontinued therapy due to toxicity (declines in PWB and functional well-being). Mean FACT-Cx TOI increased in those on the protocol longer, especially those who discontinued due to



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disease progression. However those who stayed on study longer had more deficits in neurotoxicity at the time of discontinuation. Conclusions: This study might help direct the design for second- or third-line trials for women who discontinued chemotherapy secondary to progression or toxicities.



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IGCS-0441 ORAL COMMUNICATION 2 Long-term Oncologic Effectiveness of Nerve Sparing Radical Hysterectomy in Cervical Cancer. A. Ditto1, G. Bogani2, F. Martinelli1, M. Signorelli1, S. Perotto3, C. Lopez1, C. Scaffa1, D. Lorusso3, F. Raspagliesi4 1National Cancer Institute, Gynecologic Oncology, Milan, Italy 2National Cancer Institute, Gyncologic Oncology, Milan, Italy 3National Cancer Institute, Gyneciologic Oncology, Milan, Italy 4National Cancer Instuitite, Gynecologic Oncology, Milan, Italy Background and Aims: We sought to assess safety and effectiveness of nerve sparing radical hysterectomy (NSRH) in cervical cancer patients undergoing either primary surgery or neoadjuvant chemotherapy followed by surgery. Methods: Outcomes of consecutive patients undergoing NSRH, between 2001 and 2015, and outcomes of a cohort of patients undergoing conventional radical hysterectomy (RH) were retrospectively reviewed. DFS and OS were analyzed using Kaplan-Meier and Cox models. Results: Overall, 652 patients were included: 325 (49.8%) and 327 (50.2%) undergoing NSRH and RH, respectively. We observed that nodal status is the only factor predicting for DFS (HR: 2.07 (95%CI: 1.16, 3.69); p=0.01). Type of surgical procedures (NSRH vs. RH) or surgical approach (open surgery vs. laparoscopy) did not influence risk of recurrence (p>0.2). The execution of NSRH did not correlate with an increased risk of developing local (HR: 1.32 (95%CI: 0.58, 3.01); p=0.50), regional (HR: 1.26 (95%CI: 0.41, 3.81); p=0.67) and distant (HR: 0.34 (95%CI: 0.08, 1.35); p=0.12) recurrences. Similarly, we observed that the execution of NSRH rather than RH had not a detrimental effect on OS (HR: 1.49 (95%CI: 0.20, 11.1); p=0.69). Via multivariable model, no factor directly correlated with OS; however, histology (rather than squamous), FIGO grade 3 tumor (p=0.08) and nodal involvement (p=0.06) were associated with worse OS. Early and late postoperative complication rates were similar between groups (p>0.2). Whilst, bladder, intestinal, and sexual dysfunction were significantly better in NSRH group (p50% invasion or grade3, were eligible. Primary endpoint was vaginal recurrence (VR). Competing risk method was used for VR, pelvic (PR) and locoregional recurrence (LRR: VR and/or PR) and distant metastasis (DM); Kaplan-Meier for overall (OS) and diseasefree survival (DFS); Cox regression for multivariable analysis. Results: 427 patients were randomly allocated to EBRT (n=214) or VBT (n=213). Median follow-up was 126 months (range 22-163). Table 1 summarizes 5- and 10-year actuarial event rates of all endpoints. Presence of substantial lymph vascular space invasion (LVSI) and unfavourable molecular alterations (TP53-mutation or >10% L1CAM-expression) HR 8.53 (95%CI: 2.7-27.3) and EBRT HR 0.16 (95% CI



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0.04-0.70) were independent prognostic for PR and LRR (HR 0.37 CI 0.14-0.95 and HR 6.7 CI 2.5-17.9,

respectively), but not for VR. Conclusions: Long-term analysis confirms that VBT is effective in preventing vaginal recurrence. Despite the increased PR in the VBT arm, most were combined with DM and rates of PR as first-failure; DM, OS and DFS were similar. Since VBT was associated with fewer side effects and better quality of life, VBT remains the treatment of choice for patients with HIR-EC. While the role of molecular alterations needs prospective validation, EBRT should be considered in HIR-EC with substantial LVSI.



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IGCS-0316 ORAL COMMUNICATION 3 A COMBINED MOLECULAR AND IMMUNOLOGICAL STRATIFICATION STRATEGY FOR IMMUNOTHERAPEUTIC TREATMENT OF HIGH RISK ENDOMETRIAL CANCER F. Eggink1, I.C. van Gool2, A. Leary3, P.M. Pollock4, E.J. Crosbie5, L. Mileshkin6, J. Adam3, D. Church7,8, C.L. Creutzberg9, M. de Bruyn1, H.W. Nijman1, T. Bosse2 1University of Groningen- University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, Netherlands 2Leiden University Medical Center, Department of Pathology, Leiden, Netherlands 3Gustave Roussy, Department of Medical Oncology, Villejuif, France 4Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia 5University of Manchester- St Marys Hospital, Institute of Cancer Sciences, Manchester, United Kingdom 6Peter MacCallum Cancer Centre, Division of Cancer Medicine, East Melbourne- VIC, Australia 7The Wellcome Trust Centre for Human Genetics- University of Oxford, Molecular and Population Genetics Laboratory, Oxford, United Kingdom 8Churchill Hospital, Oxford Cancer Centre, Oxford, United Kingdom 9Leiden University Medical Center, Department of Clinical Oncology, Leiden, Netherlands Background and Aims: We have recently shown that endometrial cancers characterized by a somatic mutation in the proofreading exonuclease domain of the DNA replicase polymerase epsilon (POLE) are characterized by a high mutation burden, high immune infiltration, and an excellent prognosis. The aim of this study was to extend these findings to a clinically-relevant population of high-risk endometrial cancer patients from the TransPORTEC study. Methods: To evaluate immune infiltration and activation, tissue microarray slides were analyzed for CD8+, CD103+, CD20+, CD45RO+, PD-1+ and PD-L1+ cells in the tumorcore and invasive margin using immunohistochemistry. POLE-mutant tumors were compared to3 other endometrial cancer subtypes in line with those proposed by The Cancer Genome Atlas: microsatellite instability (MSI-H), tumors expressing p53, and tumors with no specific molecular profile (NSMP). Results: POLE-mutant and MSI-H endometrial cancers showed increased infiltration of CD8+, CD103+, CD45RO+, PD-1+ and PD-L1+ cells within the tumor core. The most pronounced differences were demonstrated within the CD8+ subset. Conclusions: Our data suggest that molecular subtype in combination with quantification of CD8+ immune infiltration within the tumor core may be used to stratify high risk endometrial cancer patients for conventional or immunotherapeutic treatment. We propose minimal therapeutic intervention for POLE-mutant patients (surgery only), checkpoint inhibition for subsets of MSI and p53 patients with high CD8 infiltration, and vaccine-based strategies for NSMP patients and MSI/p53 patients with low CD8 infiltration.



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IGCS-0699 ORAL COMMUNICATION 3 Omitting Postoperative Radiotherapy for Danish Stage I Endometrial Cancer Patients at High-Risk did not Affect Survival nor Recurrence Rates. A Danish Gynecological Cancer Group Study. G. Ortoft1, C. Juhl2, C. Høgdall3, M. Dueholm1 1Aarhus University Hospital, Department of Gynecology & Obstetrics, Aarhus N, Denmark 2Viborg Hospital, Department of Obstetrics and Gynecology, Viborg, Denmark 3Copenhagen University Hospital, Department of Obstetrics and Gynecology, Copenhagen, Denmark Background and Aims: In two Danish prospective studies DEMCA demonstrated that omitting postoperative radiotherapy for stage I low- and intermediate-risk did not affect survival. In this population-based study, we evaluate if radiotherapy may be omitted for high-risk stage I patients. Methods: All Danish endometrial carcinomas (4712 patients) were included between 2005-12. Of these, 310 were final high-risk stage I (grade 3 >50% myometrial invasion; all serous/clear/undifferentiated carcinomas). Recurrence rate and Kaplan-Meier survival estimates were calculated. Data were compared to DEMCA 98-99. Results: In all, 11% received adjuvant radiotherapy and 7.2% adjuvant chemotherapy. The 5-year OS of high-risk stage I was 65 %. Adjusted hazard ratios demonstrated no effect of adjuvant therapy on OS, CCS or RFS. In 3 years 23.3% of patients recurred. If the site of the most serious recurrence were registered (distant>abdominal>pelvic>vaginal), recurrence rates were 3.2% vaginal, 0.3% pelvic, 7.1% abdominal and 12.6% distant metastasis. In all, 26 patients (8.4%) experienced vaginal recurrences, however 16 of these had concurrent non-local recurrences. Only 3 patients died after an isolated primary vaginal recurrence; one had primary insufficient RT, one received palliative therapy and one was cured by radiation, but died from a second abdominal recurrence. When the results were compared to earlier Danish national results no decrease in OS, CSS or RFS was demonstrated and also no increase in vaginal recurrences could be found. Conclusions: Omitting radiotherapy for stage I high-risk patients in a population based setting did not reduce overall, cancer specific or recurrence free survival nor increase vaginal recurrence rates.



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IGCS-0302 ORAL COMMUNICATION 3 UNFAVORABLE PROGNOSIS FOR LOW RISK ENDOMETRIAL CANCER PATIENTS WITH A DISCORDANT PRE- VERSUS POSTOPERATIVE RISK STRATIFICATION F.A. Eggink1, C.H. Mom2, K. Bouwman1, D. Boll3, J. Becker4, C.L. Creutzberg5, G.C. Niemeijer6, W.J. van Driel7, A. Reyners8, A.G. van der Zee1, G.L. Bremer9, N.P. Ezendam10, R.F. Kruitwagen11, J.M. Pijnenborg3, H. Hollema12, H.W. Nijman1, M.A. van der Aa10 1University of Groningen- University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, Netherlands 2VU University Medical Center, Center for Gynecologic Oncology Amsterdam, Amsterdam, Netherlands 3Elisabeth-Twee Steden Hospital, Department of Obstetrics and Gynecology, Tilburg, Netherlands 4Zuwe Hofpoort Hospital, Department of Obstetrics and Gynecology, Woerden, Netherlands 5Leiden University Medical Center, Department of Clinical Oncology, Leiden, Netherlands 6University Medical Center Groningen, Department of UMC staff, Groningen, Netherlands 7Antoni van Leeuwenhoek Hospital, Center for Gynecologic Oncology Amsterdam, Amsterdam, Netherlands 8University of Groningen- University Medical Center Groningen, Department of Medical Oncology, Groningen, Netherlands 9Orbis Medical Center, Departmenrt of Obstetrics and Gynecology, Sittard, Netherlands 10Netherlands Comprehensive Cancer Organization, Department of Research, Utrecht, Netherlands 11Maastricht University Medical Center, Department of Obstetrics and Gynecology and GROW – School for Oncology and Developmental Biology , Maastricht, Netherlands 12University of Groningen- University Medical Center Groningen, Department of Pathology, Groningen, Netherlands Background and Aims: In endometrial cancer (EC), preoperative risk stratification based on endometrial sampling is used to determine the extent of surgery. Unfortunately, preoperative risk stratification is not always concordant with the final pathological diagnosis. The concordance of pre- and postoperative risk stratifications and the impact of this on survival were investigated. Methods: All patients diagnosed with EC in January-June from 2005-2014 were selected from the Netherlands Cancer Registry (N=7875). Postoperative risk was determined using pathology data available in this registry. Preoperative risk was determined using preoperative pathology assessments retrieved from the Dutch Pathology Network. High risk was defined as grade 3 or non-endometrioid. Results: Both pre- and postoperative risk stratifications could be determined in 3684 patients. A discordant risk stratification was found in 10% of patients: 4% with a high pre- and low postoperative risk and 6% with a low pre- and high postoperative risk. Patients with a high pre- and low postoperative risk had an unfavorable survival when compared to those with a concordant low risk (80% and 89%, p=0.001). There was no difference in administration of adjuvant radiotherapy between these two groups (p=0.055). Survival of patients with a low pre- and high postoperative risk did not differ from those with a concordant high risk (64% and 62%, p=0.378).



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Conclusions: EC patients with a high pre- and low postoperative risk have an unfavorable prognosis compared to patients with a concordant low risk. Efforts aimed at optimizing (adjuvant) therapy for this group of patients should be considered.



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IGCS-0315 ORAL COMMUNICATION 3 ENDOMETRIAL CANCER SURVIVAL IN PATIENTS WITH TYPE 2 DIABETES: QUESTIONING THE BENEFICIAL EFFECT OF METFORMIN USE R. Arima1, E. Läärä2, M. Arffman3, P. Ilanne-Parikka4, R. Sund3, M. Hinkula1, U. Puistola1 1University of Oulu and Oulu University Hospital, Department of Obstetrics and gynecology, Oulu, Finland 2University of Oulu, Department of Mathematical Sciences, Oulu, Finland 3National Institute for Health and Welfare, Social and Health Systems Research, Helsinki, Finland 4The Finnish Diabetes Association, Medical Advisory Board, Tampere, Finland Background and Aims: To study the endometrial cancer (EC) specific survival (ECS) and overall survival (OS) in women with type 2 diabetes with metformin or other antidiabetic medications. Methods: A retrospective cohort was obtained from a nationwide diabetes registry (FinDM). Women diagnosed with endometroid EC from 1996 to 2013 were included in the study. ECS and OS were obtained using KaplanMeier methods. Multivariate analysis was performed with Cox models. Results: Of 1650 diabetic women with EC 349 (21%) were metformin only users, 342 (21%) used other antidiabetic medication, 459 (28%) other antidiabetic medication and metformin, 340 (21%) metformin, other antidiabetic medication and insulin and 97 (6%) no antidiabetic medication. In multivariate analysis patients using metformin (HR 0,54, 0,31-0,96, p 0,04), other oral antidiabetic drugs (HR 0,55, 0,33-0,92, p 0,02) or both of these (HR 0,57, 0,34-0,95, p 0,03) all had better ECS compared with the patients using insulin combined treatment (HR 0,75, 0,44-1,29, p 0,30) or no antidiabetic medication. We also compared metformin never users N=481 (29%) and metformin ever users N=1169 (71%) and found no difference in either the ECS or the OS. The cumulative dose of metformin use had no effect on the results. Conclusions: Diabetic women with endometroid EC using metformin or other oral antidiabetic medication had superior ECS and OS compared with those using insulin combined treatment or no antidiabetic medication. The beneficial effect of metformin might thus be mediated through better control of diabetes itself rather than through the specific molecular anticancer mechanisms of metformin.



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IGCS-0366 ORAL COMMUNICATION 3 EP4 RECEPTOR AND CLASS-III-β-TUBULIN EXPRESSION IN UTERINE SMOOTH MUSCLE TUMORS: IMPLICATIONS FOR PROGNOSIS AND TREATMENT A. Harper1, T. Legesse2, J. Reader3, G.G. Rao3, P.N. Staats2, A. Fulton2, D.M. Roque3 1University of Maryland School of Medicine, Department of Obstetrics- Gynecology- and Reproductive Sciences, Baltimore, USA 2University of Maryland School of Medicine, Department of Pathology, Baltimore, USA 3University of Maryland School of Medicine, Division of Gynecologic Oncology, Baltimore, USA Background and Aims: The microtubule-stabilizing agent docetaxel in combination with gemcitabine currently represents the most effective regimen against gynecologic leiomyosarcoma, an aggressive tumor with 5-year diseasespecific survival of 29-76% for stage I-IV disease. Additional biomarkers are required to predict behavior and guide novel treatment strategies. Upregulation of class-III-β-tubulin confers taxane-resistance. Prostaglandin E2 represents a hallmark of inflammation linked to pathogenesis and progression of a variety of human cancers. Its receptor, EP4, activates cAMP/PI3K/ERK pathways, and may represent a novel target for tumor inhibition. Methods: Cases of leiomyosarcoma, leiomyomatosis/STUMP (smooth muscle tumor of undetermined significance), leiomyoma, and normal myometrium were identified retrospectively from 2009-2015 within a single institution. EP4 and class-IIIβ-tubulin were characterized by immunohistochemistry in formalin-fixed tissues and Western blot in cell lines. Cell lines were treated with microtubule-stabilizing agents and EP4 inhibitor RQ-15986. Results: Patient characteristics are described in Table 1. Leiomyosarcomas dichotomously overexpress nuclear/cytoplasmic EP4 and class-III-β-tubulin (Figure 1). Cytoplasmic EP4 expression (>1+) may predict poor overall survival (8.63 months versus not reached, p = 0.07) (Figure 2A). In separate taxaneresistant cell lines that overexpressed class III β-tubulin and EP4, treatment with EP4 inhibitor was more effective than microtubule-stabilizing agents (Figure 2B/C).



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Conclusions: Expression of class-III-β-tubulin and EP4 in leiomyosarcoma may identify patients at risk of resistance to standard chemotherapies and candidates for augmentation of therapy through EP4 inhibition. Larger studies are warranted.



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IGCS-0495 ORAL COMMUNICATION 3 A DGOG OPEN-LABEL MULTICENTER PHASE II STUDY OF PAZOPANIB IN METASTATIC AND LOCALLY ADVANCED HORMONE-RESISTANT ENDOMETRIAL CANCER L. Boom1, N. Ottevanger2, A. Reyner3, J. Kroep4, E. Witteveen5, R. Lalisang6, A. Westermann1 1Academic Medical Center, Medical Oncology, Amsterdam, Netherlands 2Radboud University Medical Centre Nijmegen, Medical Oncology, Nijmegen, Netherlands 3University Hospital Groningen UMCG, Medical Oncology, Groningen, Netherlands 4Leiden University Medical Center LUMC, Medical Oncology, Leiden, Netherlands 5University Medical Center Utrecht, Medical Oncology, Utrecht, Netherlands 6Maastricht University Medical Center MUMC, Medical Oncology, Maastricht, Netherlands Background and Aims: We studied the effect of pazopanib on progression free survival (PFS) at three months in metastatic, recurrent and/or locally advanced endometrial cancer. Methods: Eligible patients had histologically or cytologically confirmed AEC, documented progressive disease and a WHO performance status of ≤ 2. All participants received treatment with pazopanib 800 mg once daily until progression, unacceptable toxicity or patient refusal. Patients were evaluable for the primary endpoint of PFS at three months if they had received pazopanib for at least four weeks. All participants were analysed for toxicity. The study was powered to demonstrate 50% PFS at 3 months (vs G, c.421+68A>C. Most of the changes were rare (frequency ranged from 1 to 3%). However, we discovered that eight known polymorphisms (rs4300410, rs3814711, rs4245443, rs72930511, rs2508740, rs2513523, rs11236775, rs3753051) were linked and created a specific genotype that was present in 31% of the patients. This genotype determined a good prognosis visible in all the patients studied (mean overall survival 1197 vs 997 days, p=0.052), and, more evidently, in the subgroup with tumor TP53 accumulation (mean overall survival 1824 vs 1040 days, p=0.004). Moreover, patients with the specific genotype and tumor TP53 accumulation had a higher rate of complete remission (CR equaling 89% vs 58%, p=0.04, OR=5.33, CI 1.08-26.42). Conclusions: Our results suggest that the specific EMSY genotype may be a good prognostic and predictive factor in ovarian cancer patients. This study was supported by the grant number N N301 5645 40 from the National Science Center.



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IGCS-1256 PREDICTIVE AND PROGNOSTIC BIOMARKER Expression of Telomerase and Patient’s Survival of Cervical Cancer Patients D. Derdameisya1, M. Soemanadi1 1Dharmais National Cancer Hospital, Obstetrics and Gynecology, Jakarta, Indonesia Background and Aims: Cervical cancer is the cancer with the second highest rate of morbidity and mortality among women in Indonesia. Nowadays, progress in understanding of cervical cancer pathophysiology leads to new measures to predict the prognosis of cancer patients. Telomerase is an enzyme complex that were linked to telomere length and important in the ageing process. In this research, We would like to see whether expression of telomerase were linked to prognosis of cervical cancer patients to better predict patient’s mortality and morbidity. Methods: Historical cohort with survival analysis were conducted on patients with early stage cervical uterine cancer that conducted radical hysterectomy procedure in Dharmais Cancer Hospital, Jakarta, Indonesia. Seventy-seven patients participated In this study. Activity of telmerase enzyme were measured using anti-hTERT antibody on histological tissue samples. Follow up were done regularly by the research team. Kaplan-meier statistical analysis were conducted to measure the patient’s survival rate linked to the expression of telomerase enzyme. Results: Bivariate analysis showed that there’s a moderate correlation between expression of telomerase enzyme to patient’s survival (r = 0.28, p= 0.019). Survival analysis with Kaplan meier showed that in general, patient’s tissue that express telomerase has higher survival rate compared to those that do not express telomerase with different mean survival of 98 months in telomerase positive vs 87 months in telomerase negative patients. Conclusions: This study validate the use of telomerase enzyme expression as one of the biomarker to predict patient’s prognosis in the future. Future study should elucidate the relationship between telomere lengths and cancer pathophysiology.



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IGCS-0310 PREDICTIVE AND PROGNOSTIC BIOMARKER Expression of UCP2 predicts the efficacy of neoadjuvant chemotherapy for locally advanced uterine cervical cancer. K. Imai1, T. Fukuda1, T. Wada1, M. Kawanishi1, R. Tasaka1, S. Nishimura2, T. Yasui1, T. Sumi1 1Osaka City University Graduate School of Medicine, Obstetrics and Gynecology, Osaka, Japan 2Kishiwada City Hospital, Obstetrics and Gynecology, Kishiwada, Japan Background and Aims: We examined the correlation between UCP2 (uncoupling protein 2) expression and the efficacy of Neoadjuvant chemotherapy (NAC) for locally advanced uterine cervical cancer. Methods: We reviewed 58 cases of locally advanced uterine cervical cancer stage IIIA-IIIB from 1995 to 2010. Cases were divided into two groups: one group in which NAC was effective, surgery was possible and radiotherapy was performed (group A; n=34), and another group in which NAC was ineffective and radiation therapy was performed (group B; n=24). UCP2 expression was examined immunohistochemically in paraffin-embedded sections using the avidin-biotin peroxidase complex method. This study was approved by the Ethics Committee in our facility. Results: The expression of UCP2 was significantly higher in the group B than in the group A (p=0.038). The overall survival of group A was significantly better than of group B (P 4 cm by MRI), between 2008 and 2010. Patients underwent a total of 5 serial DWI and FDG PET/CT examination: pretreatment, 2nd week, 4th week during CCRT, complete treatment, and 2 months later. Apparent diffusion coefficient (ADC) for DWI and maximum standardized uptake value (SUVmax) for PET/CT were measured at the primary tumor for each patient. Results: All patients completed chemoradiotherapy and scheduled examinations with a median follow-up 72 months. Tumor recurrence was observed in 20 (44.4%) of 45 patients. The 5-year disease-specific survival (DSS) and overall survival (OS) rates were 68.5%, and 66.6%, respectively. Initial tumor volume >30ml (n=28) was a significant prognostic factor with inferior 5-year DSS (56.9 vs.87.8%, p =0.025). Among patients with >30 ml tumor, the increase of mean ADC during the first two week CCRT > 0.24×10−3 mm2/s was associated with better survival (5-year DSS, 85.7% vs. 47.6%). However, the changes of SUVmax could not predict patients' outcome. Conclusions: The early changes of mean ADC could be used to identify the poor survival group and tailor the treatment for patients with bulky cervical cancer. More sophisticated SUV analysis could achieve the same purpose. Further independent validation study should be conducted to justify a change of treatment based on imaging prognostic factors.



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IGCS-1207 PREDICTIVE AND PROGNOSTIC BIOMARKER COMPARING OF TWO CLINICAL MODELS IN ESTIMATING THE RISK OF ENDOMETRIAL CANCER IN POSTMENOPAUSAL BLEEDING S. Yazdani1, M. Abedi samakoush2, Z. Bouzari1, E. Sayarifard1, M. Galeshi3 1Babol University of Medical Sciences, Department of Obstetrics & Gynecology, Babol, Iran 2Mazandaran University Of Medical Sciences, Internal medicine, Babol, Iran 3Babol University of Medical Sciences, Clinical Research Development Unit of Rouhani Hospital, Babol, Iran Background and Aims: Given the prevalence of abnormal menopausal bleeding and the importance of early examination of the condition for the early diagnosis of malignancies, the aim of study comparing of two clinical models in estimating the risk of endometrial cancer in postmenopausal bleeding. Methods: The present cross-sectional, descriptive and analytical study enrolled 112 postmenopausal women presenting to Ayatollah Rouhani Hospital, Babol, Iran. These patients underwent transvaginal ultrasound and hysteroscopy and the samples sent for pathological examination. The logistic regression model and the receiver operating characteristic (ROC) curve were used. Furthermore, models frequency of bleeding, age, diabetes, BMI cut-off value (FAD31) and A mount of bleeding, Menopause Age, Internal disease, BMI (AMI30) were defined to predict endometrial cancer in this study. Results: The present study found body mass index (BMI), menopause age, amount of bleeding and a history of having internal diseases to be statistically significant in postmenopausal women with abnormal bleeding and endometrial cancer and also higher compared to those without the cancer (P=0.007, P=0.004, P=0.001 and P=0.02 respectively). Moreover, the two models defined FAD31and AMI30. AMI30 had a high area under the ROC curve and also could predict endometrial cancer with proper sensitivity and specificity in postmenopausal women with vaginal bleeding. There were statistically significant differences among these two models (p70% of people prefer to die at home. 60% of Pelvic Cancer Patients (PCPs) who died with an underlying cause of pelvic cancer (gynecological, urological and colorectal) were aged 75+. They have shared specialty care needs, complications, and comorbidities with multiple hospital admissions and death in hospital. The aim is to examine factors determining where PCPs aged 75+ die as a ‘proxy’ for preferred place of death. Methods: A national (England) population based study using linked hospital in-patient - mortality data (123,841 PCPs aged 75+ died 2007-2015 – approximately 91% of all deaths 75+ from PC). Influence of year of death, Strategic Clinical Network (SCN) of residence, mode of hospital admission in last 90 days of life (L90DoL) and socioeconomic status based on area of residence. Results: Deaths each year rose 21% (p5 mm, invasion by ductal carcinoma in situ only, a pathological tumor size>30 mm and a pathological tumor size50% between pathological and radiological tumor size. The 7-point score allowed the classification of patients into three risk groups for RD: low (16% of patients experienced RD), moderate (65%) and high (100%). The areas under the ROC curve of the score and the logistic model were 0.72(95%CI:0.68e0.75,p 1∕4 0.60). The proportion of RD in each group of the validation population(25%, 48%, and 100% in the low, moderate and high group, respectively) confirmed the accuracy of the score in an independent population. Conclusions: This score enables the identification of patients at high risk of RD but cannot provide guidance for the decision to undertake re-excision surgery in the low-risk group. Studies are needed to test the score in extensive datasets and better identify low-risk patients.



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IGCS-0208 BREAST CANCER Breast carcinosarcoma a rare breast tumor a report about seven cases G. Montassar1, H. Bouzaiene1, H. Salhi1, M. Chemlali1, O. Haj Lamine2, M. Slimane1, A. Gammoudi2, J. Ben hassouna1, K. Rahal1 1Institut Salah azeiz of oncology, surgical oncology, TUNIS, Tunisia 2Institut Salah azeiz of oncology, Laboratoires de cytologie et d'anatomopathologie, TUNIS, Tunisia Background and Aims: Carcinosarcoma of the breast is accounting for less than 1 % of all breast malignancies. It’s a biphasic tumor defined by the presence of two malignant features, carcinomatous and sarcomatous. Our aim was to discuss the clinical aspect, the anatomopathologic characteristic and the evolution of this rare entity.

Methods: We report seven cases of breast carcinosarcoma followed up at Salah Aziez institute of oncology in Tunis between 2004 and 2016. Results: The patients included in our study were all females. The median age was 50 years . One patient had a medical history of breast carcinoma, treated 4 years prior to the developing of the carcinosarcoma. The tumor was localized in the left breast in five cases and in the right one in two cases. Clinically, three patients had a T2 tumors, three a T4b and one a T4d. The median size was 9 cm . In the histology, the tumor . The tumor was triple negative in all cases. Six patients had a radical surgery and one a conservative surgery. . The seven patients had an adjuvant treatment with chemotherapy and radiation therapy. The follow up noted a metastatic recurrence to the lung and to the liver in two cases. The follow up, of the 5 other patients showed no signs of local or distant relapse.

Conclusions: Breast carcinosarcoma is rare tumor. Their clinical and radiological aspects are non-specific. The treatment usually associates surgery to chemotherapy and radiation. The hormonal treatment has no place, due to the usual absence of hormonal receptors.



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IGCS-0999 BREAST CANCER Papillary carcinoma of the breast: a report of six cases H. Salhi1, O. Jaidane1, M. Rezgani1, M. Ghalleb1, O. El Amine2, J. Ben Hassouna1, T. Dhiab1, M. Hechiche1, K. Rahal1 1Salah Azaiez, surgical oncology, Tunis, Tunisia 2Salah Azaiez, pathology, tunis, Tunisia Background and Aims: Papillary carcinoma is a rare malignant tumor of the breast. It occurs communally in postmenopausal women. It represents approximately 0.5% of all newly diagnosed cases of breast cancer. The aim of this study is to investigate the clinico-pathological features and the treatments of papillary carcinoma of the breast. Methods: We retrospectively reviewed in this study six cases of papillary carcinoma of the breast treated between June 2005 and May 2015. Results: The patients were five women and one man. The median age at diagnostic was 58 years. The median tumor size was 2.9 cm. Four patients underwent total mastectomy and two patients had a conservative surgery. Hormonal receptors were positive in five cases. There was only one patient who had axillary lymph node metastases. Five patients had adjuvant treatment involving local radiation therapy, one of them had chemotherapy. Five patients had hormonal therapy. None of the patients had regional or distant metastases with a median follow up period of 82 months (range 12 to 123 months) after surgery. Conclusions: Papillary carcinomas have an indolent clinical course. The mainstay of treatment in these carcinomas is surgical excision. Furthermore, novel gene panels may serve as a potential decision tool in this rare entity.



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IGCS-1086 BREAST CANCER Orbital Metastasis of Breast Carcinoma H. Salhi1, M. Slimane1, M. Rezgani1, M. Ghalleb1, J. Ben Hassouna1, T. Dhiab1, M. Hechiche1, K. Rahal1 1Salah Azaiez, surgical oncology, Tunis, Tunisia Background and Aims: Breast cancer can metastasize to many sites, but the orbit is an infrequent location and a comparatively rare site of distribution among the ocular area structures. We aim in this case report to illustrate the management of a breast cancer metastatic to the orbit. Methods: Herein we report a case of an orbital metastasis of a breast cancer diagnosed in March 2015. Results: It is a case of orbital metastasis in a previously diagnosed breast carcinoma in a 48-year old woman presenting with a proptosis of her right eye bulb. An orbital magnetic resonance imaging (MRI) revealed an intra-orbital extra-bulbar mass in the right orbit. The patient had been diagnosed with an invasive ductal carcinoma of the breast 6 years before, treated by a radical surgery and a radiation therapy. She was on hormone therapy at the time of presentation of her eye symptoms. The orbital biopsy and immunohistochemical study confirmed the diagnosis. Current treatment included chemotherapy as well as local irradiation. There was a gradual improvement of local symptoms and signs. Conclusions: Intraocular metastasis is a significant and under-recognized clinical problem for the oncologist. Breast cancer is by far the most common primary site of orbital metastases. Radiotherapy is the cornerstone of management and will allow the majority of patients to maintain useful vision.



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IGCS-0085 BREAST CANCER THE COMPARISON OF CHAMOMIL TEA AND VITAMIN E EFFECT ON CYCLICAL MASTALGIA Z. Nikpouri1, K. Nikpouri1, S. Saeidi Mehrvarz1, A. Saeidi Mehrvarz1 1Ghaem hospital, Breast clinic, Rasht, Iran Background and Aims: In women cyclical mastalgia can adversely affect the quality of life and interfere with usual activities. According the tendency toward herbal remedies, we designed the present study to compare the effects of chamomile tea and vitamin E on cyclical mastalgia. Methods: One hundred sixteen women with cyclical mastalgia were randomly divided into 3 groups: chamomile (5gr, group 1), vitamin E (400gr, group 2) and placebo (folic acid, 1mg, group 3). All patients filled the modified MC Gill questionnaires before and after the treatments for two menstrual cycles. Participants in each group received treatment, starting first day of menstrual cycle to 14thday. Results: There was a significant reduction between pre and post mastalgia after first and second cycles in patients undergoing treatment with chamomile tea (P59.01 cm3 (HR=8.24, 95% CI: 1.80-37.77, P=0.007), and TLG-S >224.15 (HR= 13.09, 95% CI: 1.68-101.89, P=0.014) were associated with RFS. In multivariate analysis, FIGO stage (HR=4.87, 95% CI: 1.38-17.18, P=0.014) and MTV-S >59.01 cm3 (HR=7.37, 95% CI: 1.54-35.16, P=0.012) were determined to be independent predictive factors for RFS. Conclusions: MTV-S is an independent prognostic factor for RFS in patients with cervical cancer treated by definitive chemoradiotherapy.



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IGCS-1011 CERVICAL CANCER POST-LEEP SURVEILLANCE IN HIV-POSITIVE AND HIV-NEGATIVE WOMEN IN WESTERN KENYA O. Orang'o1, D. Chau2, T. Liu3, P. Itsura1, P. Tonui1, S. Cu-Uvin2 1Moi Teaching and Referral Hospital, Obstetrics and Gynecology, Eldoret, Kenya 2Alpert Medical School of Brown University, Obstetrics and Gynecology, Providence, USA 3Brown University, Center for Statistical Sciences, Providence, USA Background and Aims: Several studies have suggested that HIV-infected women undergoing excisional treatment for CIN have higher failure rates. Most of these studies were conducted outside of Africa, were retrospective, and several were prior to the era of highly active antiretroviral therapy (HAART) leaving much to be identified for resource-limited settings with high HIV prevalence. This study addresses surveillance outcomes after LEEP for cervical neoplasia in HIV-positive and HIV-negative women in Eldoret, Kenya. Methods: HIV-positive (n=69) and HIV-negative (n=72) women >18 years presenting 6 months post-LEEP for biopsy-confirmed CIN2 or greater were recruited from the cervical cancer screening and treatment clinic at Moi Hospital. Relevant socio-demographic and medical history was collected. Subjects underwent VIA, Pap smear, and subsequent colposcopy/biopsy for ASC-HG or higher. Results: 17.4% and 13.9% (p=0.57) of HIV-positive and HIV-negative patients developed recurrence of neoplasia (ASCUS-HG or CIN1 and higher). For patients undergoing colposcopy/biopsy, VIA demonstrated comparable sensitivities of 37.5% and 20% in HIV-positive and HIV-negative patients while Pap smear demonstrated 100% and 80% respectively (p>0.05); Pap smear had significantly higher specificity overall compared to VIA (78.6%,30.8%,p=0.02). Conclusions: In regions lacking consistent cervical cancer screening, HIV-positive women receiving HAART with good CD4 counts demonstrate similar risk of treatment failure to HIV-negative women, emphasizing a need for sensitive surveillance in both groups. Despite wider availability and cost, the risks may outweigh the benefits for VIA as a post-LEEP surveillance tool for women with high grade lesions. These findings suggest that Pap smear testing is superior to VIA for post-LEEP follow up in resource limited settings.



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IGCS-0024 CERVICAL CANCER Clinical Characteristics, Treatment and Prognosis in Stage IVB Cervical Cancer with Hematogenous Metastasis X. Cheng1, L. Haoran1 1Fudan University Cancer Hospital, Gynecolgic Oncology, Shanghai, China Background and Aims: The purpose of this study was to analyze the clinical characteristics, treatment modalities, response and prognosis of stage IVB cervical cancer patients with hematogenous metastasis. Methods: The medical records of 15 stage IVB cervical cancer patients with hematogenous metastasis were reviewed. We compared the response rate and survival between chemoradiotherapy group and chemotherapy group. Results: Among 15 patients, 7 patients received chemoradiotherapy and 8 patients underwent chemotherapy alone. The most frequent metastatic sites were Lung (46.7%，7/15) and bone (46.7%，7/15). The median overall survival (OS) was 32 months. The overall 3-year survival rate was 29.4%. The objective response (OR) rate was higher in patients treated with chemoradiotherapy compared with patients treated with chemotherapy (71.4% VS 12.5%, p=0.041). Only one patient treated with chemoradiotherapy achieved complete response. With regard to grade 3 or 4 toxicity, no significant difference was found between chemoradiotherapy and chemotherapy. No significant difference of disease progression was found between chemoradiotherapy and chemotherapy. The median progression free survival (PFS) and OS of patients with chemoradiotherapy and chemotherapy alone were 24months vs 16 months (p=0.857) and 30 months vs 16 months (p=0.030) respectively. Conclusions: Chemoradiotherapy can significantly improve the response rate and survival with accepatable toxicity in patients with stage IVB cervical cancer who have hematogenous metastasis, compared with chemotherapy alone. It deserves large scale prospective randomized clinical trial to verify.



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IGCS-0277 CERVICAL CANCER Comparison of long-term oncological outcomes and morbidities between robotic and laparoscopic radical hysterectomy in early-stage cervical cancer G.O. Chong1, Y.H. Lee1, D.G. Hong1, Y.L. Cho1, Y.S. Lee1 1Kyungpook National University Medical Center, Gynecologic Cancer Center, Daegu, Republic of Korea Background and Aims: To compare the surgical and long-term oncological outcomes and morbidity of robotic radical hysterectomy (RRH) with total laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer. Methods: Between January 2008 and December 2013, 65 consecutive patients underwent RRH and 60 consecutive patients underwent TLRH. International Federation of Gynecology and Obstetrics stage IB1 was predominant in both groups. Results: Both groups were similar with respect to patients and tumor characteristics. The mean operating time in the RRH group was significantly longer than that in the TLRH group (277.8±57.3 vs 199.6±45.0 minutes; P ASCUS or (2) two consecutive ASCUS results or (3) positive high-risk HPV. All colposcopies were performed by experienced colposcopists, and any abnormal area was biopsied. Four quadrant cervical biopsies were also taken with a baby Tischler biopsy forceps. Results: A total of 1435 colposcopies were performed over a five-year period, with 92 (6.4%) cases of high grade CIN identified, and their smear results shown in Table 1. Among the 92 cases, only 47 (51%) of them were diagnosed by colposcopic-directed biopsy. Four quadrant biopsy showed high grade CIN in an additional 45 (49%) women (Table 2). The colposcopic impression of the cases with high-grade CIN was summarized in Table 3.



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Conclusions: Performing four quadrant cervical biopsy during colposcopy greatly improved the detection rate of high grade CIN lesion.



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IGCS-1055 CERVICAL CANCER LAPAROSCOPIC RADICAL TRACHELECTOMY WITH PELVIC LYMPHADENECTOMY – CASE SERIES OF 17 PATIENTS FROM A BRAZILIAN CANCER CENTER G.F. Cintra1, M.H. Santos1, R. Reis1, C.E.M.C. Andrade1, M.M.A. Sousa1, M.A. Vieira1 1Barretos Cancer Hospital, Gynecology Oncology, Barretos, Brazil Background and Aims: With the increased incidence of cervical cancer in young women, fertility-preserving techniques such as trachelectomy have become a demand for the surgeon and a hope for patients. The laparoscopic approach has been less used than other approaches, possibly because of the technical difficulty to perform the suturing of the isthmus/residual cervix to the vaginal cuff. However, it remains an alternative access with reduced morbidity, similar oncological outcomes and good fertility rates. The objective of this study is to describe a case series of 17 laparoscopic radical trachelectomies performed at a Brazilian cancer center.Methods: Between April 2011 and Mach 2016, 17 patients with early stage cervical cancer underwent laparoscopic radical trachelectomies with pelvic lymphadenectomy. Results: The mean age was 30 years-old [20-38], mean BMI 24 [28-30]. Twelve patients (70%) were nulliparous.Mean surgical time was 204min [150 – 300], estimated blood loss 71ml [20 – 300]. All patients



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were discharged the next day. Pathological characteristics can be seen on table 1.

Two patients (11,8%) were referred to adjuvant therapy (1 chemotherapy/ 1 chemoradiation) due to poor prognosis criteria (lymph node metastasis/parametrium involvement). One patient (5,9%) recurred and is currently under chemoradiation. All other patients are alive and free of disease with mean follow up of 30 months [1-60]. One patient is pregnant (16 weeks), 2 are trying assisted fertility treatment, the remaining had no pregnancy desire so far. Conclusions: Laparoscopic radical trachelectomy is a safe treatment option in patients with early-stage cervical cancer interested in preserving fertility.



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IGCS-1183 CERVICAL CANCER Surgically staged cervical cancer patients had significant para-aortic positivity, low morbidity and reduced para-aortic recurrence when pelvic lymph nodes are suspicious G.F. Cintra1, C.E.M.C. Andrade1, M.A. Andrade1, R. Reis1, M.M.A. Sousa1, R.O. Silva2, M.H. Santos1, R. Afonso3, R. Gadia3, P.H. Souza4, R.L. Schmidt2, D. Ramone4, J.S. Nunes5, A.K. Borges6, R.R. Rossini6, M. Simonsen1, D.C. Lacerda4, G. Macedo7, A.T. Tsunoda5 1Barretos Cancer Hospital, Gynecology Oncology, Barretos, Brazil 2Barretos Cancer Hospital, Surgical Oncology, Barretos, Brazil 3Barretos Cancer Hospital, Radiation Oncology, Barretos, Brazil 4Barretos Cancer Hospital, Medical Oncology, Barretos, Brazil 5Erasto Gaertner Cancer Hospital, Gynecology Oncology, Curitiba, Brazil 6Barretos Cancer Hospital, Radiology, Barretos, Brazil 7Barretos Cancer Hospital, Pathology, Barretos, Brazil Background and Aims: Nodal metastasis in cervical cancer has prognostic and therapeutic implications, and staging lymphadenectomy has become a standard of care. Positive pelvic lymph nodes might implicate in 11% to 25% of occult para-aortic metastasis. Aim: To compare outcomes from patients with pelvic suspicious lymph nodes who underwent laparoscopic surgical staging with the clinically staged, in a Brazilian cancer center. Methods: Between Aug/2013 and Jan/2016, 52 cervical cancer patients with suspicious pelvic and normal paraaortic lymph nodes at MRI were selected. Exclusion criteria: Age>70yo and ASA>=3. Results: In the surgically staged group, 10/30 (34.5%) patients had para-aortic metastasis. All received extendedfield chemoradiation, one (10%) had a lung recurrence, while the remaining 9 are alive and free of disease (max. FUP 27mo). There were no intra-operative complications, mean blood loss was 37cc, and 3/30 had postoperative surgical complications Grades 1-2. Mean time for chemoradiation was 28 days (14-44) and 7 (1-19), (pCIN II lesion was 54% and %73 in patients having ASC-H and HSIL cytology results. Also high grade lesion rate was more than 30% of patients with ASCUS and LSIL cytology results. Positive margin was significantly higher in >CIN II compared to CIN I lesion (36% vs 4%). ECC positivity was seen only 3% in patients having >CIN II lesion. There was no significant correlation between satisfaction of colposcopy, age, number of fragments and surgical margin status. Conclusions: The patients having HSIL vaginal cytology results should be managed with see and treat protocol. ECC is unnecessary procedure in this group patient, if colposcopy is satisfactory. Also, ASCUS cytology results should be referred to colposcopic examination.



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IGCS-0437 CERVICAL CANCER Laparoscopic Radical Parametrectomy video presentation F. Demirkiran1, T. Bese1, V. Sal1, I. Kahramanoglu1, H. Turan1, N. Tokgozoglu1, M. Arvas1 1Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gynecology, Istanbul, Turkey Background and Aims: Laparoscopic radical parametrectomy is a reasonable surgical approach for patients underwent simple hysterectomy for cervical cancer. Methods: A-46 year-old woman was referred to our clinic after simple hysterectomy for CIN III punch biopsy result. Final pathology result of this operation was squamous cell carcinoma with LVSI and pathologic tumor size was 23 mm. Bimanual vaginal and rectal examination was normal and there was no pathologic FDG uptake at pet-CT. With these findings, laparoscopic radical parametrectomy was suggested to the patient.

Results: Patients were placed in semi-lithotomy position with legs in a neutral position Four trocars were utilized: a 10 mm 2 cm supra-umbilical, two 5 mm para-median and a 10 mm supra pubic midline trocars were placed. After these procedures, the first step is incision to the pelvic side wall peritoneum paralel to infundibulopelvic ligaments. The para- rectal and para-vesicular spaces were then developed down to the pelvic floor. Uterine arteries were divided at their origins. The ureters were dissected in whole pelvis up to bladder. Then the vesicovaginal space was entered and the bladder disected. During this procedure, injury occurred at lower part of bladder and it was repaired. The dissection was carried out until the upper one third of vagina. A colpotomy incision was made on the anterior aspect of the vagina removing at least 2–3 cm of the upper vagina after transacting parametrium and uterosacral ligaments. Then lymphadenectomy was performed. Conclusions: In conclusion, laparoscopic radical parametrectomy is a safe and feasible procedure for selected patients with occult invasive cervical cancer.



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IGCS-0745 CERVICAL CANCER Radical Laparoscopic Trachelectomy after neoadyuvant chemotherapy J. di guilmi1, M.C. Darin1, R. Verdura1, A.G. Maya1 1Hospital Britanico Buenos Aires, Ginecologia, Ciudad Autónoma de Buenos Aire, Argentina Background and Aims: Tumors with more than 2 cms. represents a challenge in order to preserve fertility in young women. In a recent review about 65 cases with fertility sparing after neoadjuvant chemotherapy al surgeries were abdominal, robotic and vaginal, and none of them were completely performed by laparoscopy. Methods: We present a 33 years old, non gravida woman. Recently diagnosed with a IB1 squamous cervical cancer without LVSI Tumor size: 24x23 mm. Without aparent node disease in images (ADC difussion RMI). After 3 cycles of neoadjuvant chemotherapy with cisplatin / paclitaxel iq 7 days she had a significant tumor size reduction with residual tumor size 14 mm in postreatment RMI. We performed a completle laparoscopic approach. Starting with pelvic lymphadenectomy with frozen section. With negative pelvic nodes, the surgery continued with parametrectomy and tracheletomy preserving hipogastric nerves. Using a "smith sleeve" to avoid cervical stenosis.The frozen section of the cervix showed more than 5 mm margen free of disease Results: Total Operative length: 295 minutes. No blood transfusions were required. Discharge after 48 hs. with urinary cateter. Smith sleeve was removed after 20 days. The patient is free of disease 16 months after surgery. Conclusions: As far as we know, there are no reports of trachelectomies after neoadyuvant chemotherapy performed totally by a laparoscopic approach. Results in terms of overall survival are needed to determine if radical laparoscopic trachelectomy after neoadjuvant procedure in selected patients with strong fertility desires.



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IGCS-0068 CERVICAL CANCER PRIMARY DIFFUSE LARGE B-CELL LYMPHOMA OF THE UTERINE CERVIX PRESENTING WITH BILATERAL HYDRONEPHROSIS B. Díaz de la Noval1, I. Zapardiel1, A. Hernández Gutiérrez1, J. De Santiago García2, M.D. Diestro Tejeda1 1University Hospital La Paz, Gynecology Oncology Unit, MADRID, Spain 2University Hospital La Paz, Gynecology Oncology Chief Department, MADRID, Spain Background and Aims: Primary Large B-cell extranodal lymphoma of the cervix is a very rare disease and can present with bilateral hydronephrosis from obstruction by the tumor mass. Because of the rarity of this tumor the diagnosis and therapy are often difficult and delaying. The aim is to provide an updated review of the literature and report a recent case in our institution. Methods: Literature analysis and description of a clinical case. Results: Case report. We describe a 46-year-old healthy woman with primary extranodal non-Hodgkin’s diffuse large B-cell lymphoma of the uterine cervix Ann Arbor stage IIEA IPI 1. She presented an acute renal failure and severe ureterohydronephrosis successfully treated with 6 courses of chemotherapy based on Rituximab plus Cyclophosphamide, Doxorubicin, Vincristine and Prednisone (R-CHOP) with no major side effects. Conclusions: Discussion. Symptoms are usually non-specific and the diagnosis is difficult to reach. Diffuse Large Bcell lymphoma is the most common histology type of extranodal non-Hodgkin’s lymphoma. Therapy is still under discussion but chemotherapy with R-CHOP or CHOP-like regimens are preferred with a better prognosis and high overall survival. Conclusion. in case of a young woman with a big well defined uterine cervical mass, bilateral ureteral entrapment and an uncertain Pap or biopsy tests, the presence of a lymphoma should be considered. Biopsy and immunophenotypical evaluation are essential for diagnosis.



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IGCS-0186 CERVICAL CANCER ELDERLY WOMEN WITH CERVICAL CANCER ARE LESS LIKELY TO UNDERGO SURGERY AND HAVE LOWER OVERALL SURVIVAL COMPARED TO WOMEN UNDER 65 YEARS OLD E. Diver1, E. Hinchcliff1, A. Gockley1, A. Melamed1, L. Contrino2, S. Feldman2, W. Growdon1 1Massachusetts General Hospital, Gynecologic Oncology, Boston, USA 2Brigham and Women's Hospital, Gynecologic Oncology, Boston, USA Background and Aims: The aim of this study is to understand the treatment patterns and clinical outcomes of elderly women with cervical cancer, compared to younger women. Methods: Women undergoing care for cervical cancer between 2000 and 2013 at two academic institutions were identified. The cohort of elderly patients was defined as >65 years old at diagnosis. Patient charts were retrospectively reviewed, and clinical variables were extracted. Fisher’s exact tests, logistic regression, and Kaplan-Meier analyses were performed. Results: From 2000-2013 1,119 women with cervical cancer were identified. Of these, 191 (17.0%) were >65 years old at the time of diagnosis. Elderly women were more likely to present with higher stage disease (p10 cells thick were classified as classic HSIL. Immunohistochemical p16ink4a staining was used to confirm lesions of thin HSIL.

Results: Results: Overall, 19 (76%) specimens contained both thin HSIL and classic HSIL; 4 (16%) contained thin HSIL only; 1 (4%) contained classic type HSIL only; and 1 (4%) contained thin HSIL and LSIL. Thin HSILs developed in both the columnar surface epithelium and deep cervical glandular epithelium. Most thin HSILs were 5 cells thick. All HSILs (thin and classic) were located inside the transformation zone and had a median horizontal extension of 8 (0.3-21) mm. Conclusions: Conclusions: Our findings suggest that thin HSILs are frequent findings in cone specimens, that they coexist with classic HSIL, and preferably arise in the exposed parts of the transformation zone including the glandular crypts.



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IGCS-0081 CERVICAL CANCER HOW SENTINEL LYMPH NODE COULD SUPPORT LESS RADICAL SURGERY IN THE MANAGEMENT OF EARLY STAGE CERVICAL CANCER? I. Koutroumpa1, N. Thomakos1, M. Sotiropoulou2, D. Haidopoulos1, G. Vlahos1, A. Rodolakis1 1Alexandra Hospital - University of Athens, 1st Department of Obstetrics and Gynecology, Athens, Greece 2Alexandra Hospital - University of Athens, Department of Hystopathology, Athens, Greece Background and Aims: Parametrial invasion (PI) in early stage cervical cancer (CaCx), IA2-IB1, with less than 10mm depth of Invasion (DOI) and negative lymph nodes (LN) is less than 0.6%. Since, sentinel lymph node (SLN) reliably predicts a possible LN metastasis; we aim to develop a single algorithm detecting the SLNs, in order to avoid lymphadenectomy and radical parametriectomy in the surgical management of such tumours.

Methods: Prospective study including patients with CaCx, stage IA1- IB2. One-step protocol: induction of anaesthesia, intracervical injection of methylene blue, detection and removal of dyed LNs, frozen section biopsy (FSB), followed by bilateral pelvic lymphadenectomy and radical hysterectomy. Results: Forty patients were eligible in our study. At least one SLN (range 0-6) was identified in 82.5% (33/40), whereas bilateral detection in 70% (28/40). SLNs were located at the external (53.8%) or internal iliac region (15.4%), obturator fossa (19.2%), and ventral to the hypogastric vessels (11.6%), whereas 9.1% found in an unexpected (parametrium) area (tumour size TS ≥ 2.2 cm). PI was not detected when SLNs were negative for disease. FSB was positive in 4 cases (10%) and the procedure was aborted. SLN sensitivity in detection of metastasis was 100 % for TS < 2.2 cm. Median follow-up was 13.2 months (range 1-28) with no evidence of disease so far. Conclusions: Our findings confirm the clinical significance of SLN mapping in minimizing systematic lymphadenectomy and support less radical surgery in cases of negative SLNs and tumors with TS ≤2.2cm.



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IGCS-0361 CERVICAL CANCER RE-IRRADIATION OF LOCALLY RECURRENT GYNECOLOGIC CANCERS: A SINGLE-INSTITUTION EXPERIENCE R. Schillinger1, N. D'Emic2, E. Nichols2, P. Mohindra2, M. Pectasides3, G.G. Rao4, D.M. Roque4 1University of Maryland School of Medicine, Department of Obstetrics- Gynecology- and Reproductive Sciences, Baltimore, USA 2University of Maryland School of Medicine, Department of Radiation Oncology, Baltimore, USA 3University of Maryland School of Medicine, Department of Radiology, Baltimore, USA 4University of Maryland School of Medicine, Division of Gynecologic Oncology, Baltimore, USA Background and Aims: Re-irradiation (re-RT) after radiation therapy (RT) for curative intent is controversial secondary to presumed poor tissue tolerance. While re-RT has been employed with success in head/neck and rectal cancers, reports among gynecologic malignancies are lacking. We describe clinical outcomes and tolerability with this approach across a single institution. Methods: Patients who received RT for curative intent for gynecologic cancer followed by re-RT between 19992014 were identified retrospectively. Descriptive statistics and Pearson correlation were employed. Overall survival (OS) was analyzed according to the Kaplan-Meier method. Results: A total of 15 patients undergoing 16 instances of re-RT for cervical (n=10, 67%), endometrial (n=3, 20%), vulvar (n=1, 7%), and vaginal (n=1, 7%) cancer were identified. Characteristics are described in Figure 1. Median interval to re-RT was 52.2 months (range: 8.6-176.5). Median OS following re-RT was 20.3 months. There were no treatment-related deaths. Five patients (33%) had no toxicity, but 3 (20%) experienced ≥one grade 3 toxicity including fibrosis (n=1), urinary retention (n=1), pain (n=2), fatigue (n=1), and/or vomiting (n=1). Time to re-RT was weakly correlated with OS following re-RT (R2=0.63). Median OS after re-RT was longer in patients with time to re-RT >52 mo (21.4 mo) compared to 400 patients in September 2016. Full exome sequencing data from the first 100 BioRAIDs patient tumors are completed and a targeted panel has been designed for all subsequent patients. Biological and clinical curated data of 100 patients will be available at the IGCS meeting, allowing to define which molecular alterations do not permit complete response to well conducted standard therapies. Progression free survival data at 12 months will be available. Results The first evaluation revealed predominant mutations in several pathways including the PI3K pathway, chromatin remodelling and loss of function mutations of the suppressor gene FBWX7 among others. Using the gene list of ACSN (atlas for cancer signalling network), 5 clusters could be defined. In parallel to mutational analysis, copy number variations and RPPA as well as circulating tumour DNA are integrated into a molecular diagnostic roadmap for each patient. Stratification analysis showed molecular profiles available from 20 cervical cancer cell lines to cluster in only 2 out of the 5 clusters; these 2 clusters are enriched in dysfunctions of oxidative phosphorylation and of mitochondrial energy production (Warburg effect). Discussion An algorithm for a future clinical validation study is discussed. Strategies to enlarge cancer treatment options will take into account the profiles of patient most at risk, as well as the drug availability/cost of alternative treatment options. Precision medicines, targeting specific pathways as well as “old” drugs with efficacy on non cross resistant targets will be assessed.



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IGCS-0379 CERVICAL CANCER THE PREVALENCE OF HPV TYPES IN WOMEN WITH CIN 2-3 OR CERVICAL CANCER IN HAIFA DISTRICT, ISRAEL Y. Segev1, E. Siegler1, M. Schmidt1, L. Machulki1, R. Auslender1, O. Lavie1 1Carmel Medical Center, Obstetrics and Gynecology, Haifa, Israel Background and Aims: Human Papilloma Virus (HPV) is classified as biologic carcinogen causing cervical cancer. We intend to identify the HPV types responsible for cervical cancer and pre-cervical cancer in Israel. Methods: This was a retrospective study which included 226 women, diagnosed with CIN 2-3 and 115 women diagnosed with cervical cancer, and tested for HPV typing. Results: HPV was detected in 92.9% of women with CIN 2-3 and HPV–HR was detected in 85.8% of them. In women with cervical cancer HPV was positive in 96.5%, and HPV–HR detected in 93%. The most common HPV types among the CIN 2-3 were 16(42%), 31(8.8%) and 18 (4.9%) and in the cancer patients HPV 16 (57.4%), 45 (9.6%), and 18(7.8%). The chief complaint led to cancer diagnosis was post menopause bleeding (27%), while abnormal Pap test lead to CIN 2-3 diagnosis in 75.2% of the women. The common PAP finding was ASCUS (36.4%) in CIN 2-3 group and HSIL in cancer group (32.1%). Only 22.6% of women diagnosed with cancer were diagnosed due to abnormal Pap test and 76.9% of them were diagnosed at stage I, as compared to women diagnosed with cancer following symptoms, of them 57.1 % were diagnosed at stage I (p2 cm and/or involving >2/3 of cervical stroma. Simple vaginal trachelectomy or conization were performed according to tumor extent. The follow-up period started once free surgical margins were reached.

Results: Out of 44 women enrolled, 32 women (IA2 = 7, IB1 = 23, IB2 = 2) successfully completed FSS. NAC was administered in 9 (28.1 %) cases. During the follow-up, 18.8 % (6/44) women become pregnant. Of these, 1 miscarried and 5 successfully delivered. Disease recurred in 6 patients; 5 recurrences were central and 1 recurrence presented as an ovarian mass. Invasive cervical carcinoma, HSIL, and LSIL lesions were detected in 4, 1 and 1 patients, respectively. Three of them received NAC. All events were detected within 16 months. Conclusions: Nearly 27 % of patients cannot complete FSS due to node positivity, progression during NAC, or involved margins. The total recurrence rate reached 18.8 %, with the majority of invasive recurrences detected in patients after NAC followed by FSS. These patients represent cases at a higher risk of recurrence even if adequate free margins are reached by surgery.



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IGCS-0325 CERVICAL CANCER SENSITIVITY OF FOLLOW-UP METHODS IN PATIENTS AFTER FERTILITY SPARING SURGERY FOR CERVICAL CANCERS J. Slama1, D. Cibula1, M. Zikan1, D. Fischerova1, R. Kocian1, A. Germanova1, F. Fruhauf1 1General University Hospital and First Faculty of Medicine - Charles University, Gynecologic Oncology Center, Prague, Czech Republic Background and Aims: The aim of our study was to compare sensitivity of various methods in follow-up of cervical cancer patients after fertility-sparing surgery (FSS). Methods: Included were women with cervical cancer stages IA2 – IB2 who underwent FSS, which comprises of pelvic lymphadenectomy, SLNB, abdominal radical trachelectomy, vaginal trachelectomy or conization. Follow-up visits were scheduled in 3 months intervals and included symptoms oriented discussion, gynecological and physical examination, colposcopy, Pap smear, HPV test including 16/18 genotyping and ultrasound examination. All cases with recurrent disease were throughly analysed and results of individual examinations were compared. Results: Altogether 43 women (IA2 = 8, IB1 = 33, IB2 = 3) were enrolled. Abdominal radical trachelectomy was performed in 10, vaginal trachelectomy in 11 and conization in 22 of women according to the tumor characteristics. Median duration of follow-up reached 37 months. Invasive cancer, HSIL and LSIL lesions were detected in 8, 1 and 1 patients respectively. All except one event were detected within the 1 st year after FSS. Only 2 cases were symptomatic. Colposcopy detected 7 out of 10 recurrences, 5 of them were HPV positive, in 2 cases Pap smear revealed abnormalities. Pap smears were false positive in 27.7%, especially after trachelectomies. Conclusions: Majority of patiets who recurre after FSS reveal central or pelvic lesion, which can be successfully treated. Early detection of recurrence is an essential condition for favourable oncological outcome. Colposcopy alone and in combination with HPV positivity showed the highest sensitivity for detection of recurrent disease, while other methods had limited reliability.



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IGCS-1045 CERVICAL CANCER THE PREVALENCE OF HIGH RISK HPV SEROTYPES IN HAITIAN WOMEN WITH CERVICAL CANCER K. Hew1, R. Garcia2, A. Garcia-Soto1, P. Desai1, B. Slomovitz1, E. Kobetz3 1University of Miami, Obstetrics and Gynecology, Miami, USA 2University of Miami, Miller Scool of Medicine, Miami, USA 3University of Miami, Public Health, Miami, USA Background and Aims: The incidence of cervical cancer in Little Haiti, South Florida (34 per 100,000) is nearly four times higher than that reported for the Miami metropolitan area (9 per 100,000 ). Recent studies have shown that the commonest high risk HPV serotypes associated with abnormal cervical cytology were HPV 82, 35 and 61 in Haitian women. The primary objective of this pilot study was to describe the high risk HPV serotypes present in cervical cancer specimens of Haitian women. The secondary objective was to determine their impact on survival in this population. Methods: A retrospective chart review of 40 Haitian patients diagnosed with invasive cervical cancer between 20072013. Data collected included demographics, clinico-pathologic and treatment parameters. Cervical carcinoma tissue samples were obtained at the time of diagnosis and tested for high risk HPV serotypes using multiplex PCR with type-specific primers. Survival analyses were performed with the Kaplan-Meier method and compared using log-rank testing. Results: 34 (85%) patients had successful extraction of DNA from cervical cancer tissue specimens .The commonest high risk HPV serotype found was HPV 16 (85.3%). This was followed by HPV 31 (11.8%), HPV 18 (8.8%), HPV 35 (5.9%) and HPV 66 (5.9%). The co-infection rate was 23.5% (N=8).There was no difference in overall survival between patients with co-infection versus single infection, P=0.13. Conclusions: HPV 16 is the most prevalent serotype found in cervical cancer of Haitian women. There is a higher than expected co-infection rate. Larger studies are needed to explore these findings and direct future preventive strategies in this population.



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IGCS-0555 CERVICAL CANCER NEOADJUVANT CHEMOTHERAPY (NCH) FOLLOWED BY ABDOMINAL RADICAL TRACHELECTOMY (ART) IN CERVICAL CANCER: LONG TERM FOLLOW UP RESULTS OF THE BUENOS AIRES EXPERIENCE. A. Soderini1, A. Aragona2, M.E. Bonavia3, H. Moschen2, G. D´Amico4, R. Garrido2, N. Cuneo2 1ONCOLOGIC HOSPITAL of Buenos Aires "Marie Curie", gynecologic Oncology, Ciudad Autónoma de Buenos Aire, Argentina 2Oncologic Hospital of Buenos Aires "Marie Curie", Gynecologic Oncology, Buenos Aires, Argentina 3Oncologic Hospital of Buenos Aires"Marie Curie", gynecologicOncology, Buenos Aires, Argentina 4Oncologic Hospital of Buenos Aires"Marie Curie", Gynecologic Oncology, Buenos Aires, Argentina Background and Aims: OBJECTIVES: To analyze the long term follow up results of NCH followed by ART in stages Ib1 >2cm and < 4 cm squamous cervical carcinomas Methods: Prospective trial over 27 pts. submitted to an ART . In five cases stages Ib1, (tumor >2 & 2 &2.5 cm) and/or pelvic LN metastasis should be performed with adjuvant chemotherapy. Conclusions: Our data suggested that ART could be performed safely and open up possibilities of pregnancy if the tumor size was less than 2.5cm. Although fertility-sparing surgery for early stage cervical cancer might be controversial, ART could be one of the treatment modalities.



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IGCS-0820 CERVICAL CANCER Factors related to tumor size reduction after neoadjuvant chemotherapy in patients with bulky early-stage cervical cancer (>2cm lesions) Y. Yao1, H. Guo1 1Peking University Third Hospital, Gynecology, Bei Jing, China Background and Aims: The role of neoadjuvant chemotherapy (NAC) followed by surgery is not yet widely accepted for the treatment of early stage cervical cancer. NAC before surgery has already shown the effectiveness in selective patients especially locally advance cases which reveals short-term effect in reduction of tumor size. In this study we evaluated the factors related to the tumor size reduction after neoadjuvant chemotherapy in patients with bulky early-stage cervical cancer (>2cm lesions). Methods: 50 patients with stage Ib1 to IIa2 (>2cm lesion) cervical squamous cell carcinoma (SCC) were studied. Patients received 2 cycles of paclitaxel 135-175mg/m2 and cisplatin 70 mg/m2 of a 21-day course intravenously after diagnosis of SCC through cervical biopsy. MRI was performed before chemotherapy and surgery to evaluate the tumor size by diameter volumetry. SCC antigen level before chemotherapy, clinical stage, growing pattern, pathology type, tumor cell differentiation degree was studied and relations between these factors and tumor size reduction were calculated with the Pearson Correlation Coefficients analysis. Results: Tumor size reduction and SCC-Ag level correlated well (r=0.580, P1cm diameter) and median tumor size was 5.7cm (Table 1). In this subgroup, treatment with CA4P+Bev compared with Bev alone was associated with significantly improved PFS (3.7 months) and a non-significant trend of improved OS (5.6 months; HR 0.777; P=0.377). In 40 patients with larger tumors (>5.7cm), PFS increased (6.2 months) in CA4P+Bev versus Bev alone. Adverse events were as reported previously..



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Table 1.

Median PFS, months CA4P+Bev Bev alone HR; P Measurable Tumor >1 cm, n=81 HR=.600; P=.027 9.8 (n=42) 6.1 (n=39) Tumor Size >Median (5.7cm), n=40 HR=.554; P=.071 10.5 (n=20) 4.3 (n=20) Tumor Size 30 years, normal preoperative calcium levels, tumor sizeBMI>18.5 (Group A), overweight when BMI>25.0. (Group B) Toxicity was graded according with Common Terminology Criteria for Adverse Events. Platinum-free (PFI) was estimated as the time elapsed from completion of first line chemotherapy, and date of recurrence/progression or last follow-up. Overall Survival (OS) was calculated from diagnosis to death of disease or last follow-up. Results: Median BMI of the whole study population was 22.2 (19.0-37.0), 57 patients (77.0%) were allocated in Group A, and 17 women (23.0%) in Group B. Median PFI of the study population was 16 months (2-65). In both groups median PFI was 16 months (p-value=0.813). No OS differences were observed between groups (Group A 60 months Vs Group B 64 months; p-value=0.403). G3/4 Hematologic toxicity occurred in 26 women (45.6%) in Group A, and 3 patients in Group B (17.6%, p-value=0.041). Non hematologic toxicity was observed in 46 (80.7%) patients in Group A, and in 9 women (52.9%) in Group B (pvalue=0.021). Conclusions: No survival differences were observed according with BMI. A higher incidence of haematologic and nonhematologic toxicity was documented in patients with normal compared with overweight BMI.



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IGCS-0364 OVARIAN CANCER AGE-RELATED EFFICACY AND SAFETY OF FIRST LINE BEVACIZUMAB PLUS CARBOPLATINPACLITAXEL IN ADVANCED OVARIAN CANCER (AOC). C. Ricci1, V. Salutari1, M. Petrillo1, G. Amadio1, I. Paris1, A. Fagotti1, R. De Vincenzo1, M. Distefano1, E. Palluzzi1, S. Giovannoni1, M.G. Ferrandina1, G. Scambia1 1Università Cattolica del Sacro Cuore, Gynecologic Oncology, ROMA, Italy Background and Aims: No study about bevacizumab in AOC investigated efficacy and safety differences according to age subgroups. Methods: This is a case-control study including 222 AOC patients. Seventy-four women treated with first line carboplatin-paclitaxel-bevacizumab chemotherapy (Cases) were matched based on laparoscopic predictive index value, and residual tumor with 148 AOC patients treated with carboplatin-paclitaxel (Controls).Three groups were considered: 70 yrs (Group C). Results: Median age was 57 yrs (26-86), 54 yrs (26-76) in Cases, and 58 (27-86) in Controls (p-value=0.236). 121 women were allocated in Group A, 60 in Group B, and 41 in Group C. Median PFI was 16 months (range 2-65) in Cases, compared with 9 months (1-83) in Controls (p-value=0.001). In group A, Cases showed a median PFI of 35 months (2-65) compared with 10 months (1-66) in Controls (p-value=0.001). In Group B median PFI was 11 months (2-42) in Cases compared with 9 months (3-48) in Controls (pvalue=0.554). In Group C median PFI was 15 months in Cases (1-39) and 11 months in Controls (2-57; pvalue=0.293). No differences were observed in term of OS and main toxicities in the overall population, also stratifying by age groups. Conclusions: Bevacizumab prolongs PFI in AOC, but not OS. The benefit in term of PFI seems to be higher in young patients with age70 yrs.



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IGCS-0520 OVARIAN CANCER OVARIAN GONADOBLASTOMA WITH MIXED GERM CELL TUMOR IN A 16-YEAR-OLD GIRL WITH 46, XX KARYOTYPE: A CASE REPORT Z. Firat Cuylan1, M.E. Sari1, A.L. Sirvan2, T. Gungor1, M.M. Meydanli1 1Zekai Tahir Burak Women Health Care Education and Research Hospital, Gynecologic Oncology, ANKARA, Turkey 2Zekai Tahir Burak Women Health Care Education and Research Hospital, Pathology, ANKARA, Turkey Background and Aims: Mixed germ cell neoplasms consist of two or more admixed types of ovarian germ cell neoplasms (OGCNs). They account for 5.3% of all malignant OGCNs. Components of dysgerminoma mixed with a yolc sac tumor are the most common. We report a rare case of 16-year-old-girl who presented ovarian gonadoblastoma with mixed germ cell tumor. Methods: A 16-year-old girl presented with secondary amonere. PET-CT revealed millimetric calcifications and hypodense space in her right ovary together with a 26x26 mm sized, heterogeneous, locally increased FDG uptake (SUV max: 7). Serum human chorionic gonadotropin (bHCG) was 307.6 mIU/ml (0-5), other tumor marker levels were unremarkable. The patient went under laparotomy and a 3 cm cystic mass in the right ovary has been detected. Right salpingooophorectomy was performed, since frozen section revealed malignant mixed germ cell tumor, surgical staging was performed upon fertility sparing basis. Results: Histopathology examination revealed; Mixed germ cell tumor (dysgerminoma (approximately 80%), embryonal carcinoma (5-10%) and mature teratoma (5-10%)) together with gonadoblastoma; in the right ovary. Douglas cytology was reported as malignant. In areas with embryonal carcinoma, neoplastic cells SALL4, CD30 and cytokeratin were positive. Tumor was 3x2 cm in size. Capsule invasion and lympho vascular space invasion were detected. The patient staged as IC3 and four cycles of BEP was administered. The patient is alive without disease six months after surgery. Conclusions: Malignant mixed germ cell tumors are aggressive, fast growing tumors. However, they may present as large adnexal mass, as in this case.



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IGCS-0523 OVARIAN CANCER INSULAR OVARIAN CARCINOID TUMOR EMERGED FROM MATURE CYSTIC TERATOMA TOGETHER WITH FIBROMA AND LEDYING CELL HYPERPLASIA: A CASE REPORT Z. Firat Cuylan1, N. Topfedaisi Ozkan1, K.H. Muftuoglu2, M.M. Meydanli1, T. Gungor1 1Zekai Tahir Burak Women Health Care Education and Research Hospital, Gynecologic Oncology, ANKARA, Turkey 2Zekai Tahir Burak Women Health Care Education and Research Hospital, Pathology, ANKARA, Turkey Background and Aims: Primary ovarian carcinoid tumors are less than 0.1% of all ovarian malignancies. They are generally unilateral and most frequently observed in perimenopausal women. Metastatic carcinoid tumor is more common than the primary carcinoid tumor of the ovary. A case of insular ovarian carcinoid tumor emerged from mature cystıc teratoma together with fibroma and ledying cell hyperplasia is presented. Methods: 71-year-old patient applied to our clinic with pelvic pain. Abdominal CT revealed right ovarian cyst, 25x25mm in size, containing fat component and millimetric calcification, considered as teratoma. The patient underwent hysterectomy and bilateral salpingooophorectomy with the diagnosis of complicated adnexal mass. Results: Histopathologic examination revealed insular ovarian carcinoid tumor emerged from mature cystıc teratoma. Carcinoid tumor was approximately 0.6 cm in size, there were ledying cell hyperplasia around tumoral areas and fibroma that was 0.8 in diameter were in the neighboring area. Immunohistochemical staining in the carcinoid tumor area results were chromogranin and synaptofizin positive, whereas the ledying cell areas were inhibin positive. Carcinoid was typical, with uniform cells in the tumoral areas, small nucleus, without necrosis. In addition; T) was detected. Results: Thereafter she decided to have RRSO. Conclusions: In this case occult cancer was found as the extremely small lesion in the edge of left fallopian tube. Finally she was performed staging laparotomy following NCCN guideline for ovarian and fallopian cancer.



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IGCS-0700 OVARIAN CANCER OUTCOME ACCORDING TO RESIDUAL DISEASE (SURGEON’S REPORT VERSUS PRECHEMOTHERAPY IMAGING) IN BEVACIZUMAB-TREATED OVARIAN CANCER PATIENTS: ANALYSIS OF THE ROSIA STUDY J. Korach1, N. Colombo2, C. Mendiola3, F. Selle4, N. Martin5, S. Robb5, A. Oza6 1Sheba Medical Center, Gynecologic Oncology Department, Tel Hashomer, Israel 2European Institute of Oncology and University of Milan-Bicocca, Division of Medical Gynecologic Oncology, Milan, Italy 3Hospital Universitario 12 De Octubre, Department of Medical Oncology, Madrid, Spain 4Groupe Hospitalier Diaconesses Croix Saint Simon and Alliance Pour la Recherche en Cancérologie, Department of Medical Oncology, Paris, France 5F Hoffmann-La Roche Ltd, Pharma Development Medical Affairs, Basel, Switzerland 6Princess Margaret Hospital- University of Toronto, Department of Medical Oncology, Toronto, Canada Background and Aims: The single-arm ROSiA study evaluated an extended duration of front-line bevacizumab in 1021 patients with ovarian cancer. We explored efficacy according to surgically and radiologically assessed extent of post-operative residual disease and examined how discordant assessment may affect patient outcomes. Methods: Patients with FIGO stage IIB‒IV or grade 3 stage I‒IIA ovarian cancer received bevacizumab 15 (or 7.5) mg/kg q3w and 4‒8 cycles of carboplatin–paclitaxel after debulking surgery. Single-agent bevacizumab was continued until progression or up to 24 months. The primary endpoint was safety; progression-free survival (PFS; by RECIST/symptomatic deterioration) was a secondary endpoint. We performed post hoc exploratory analyses of PFS in the following four subgroups: no visible residuum (NVR) per surgeon report but with target lesions by RECIST on scanning; NVR per surgeon report without target lesions; macroscopic (≤1cm) residuum; and >1cm residuum. Results: Surgical and radiological assessments were concordant except in 61 patients (NVR with target lesions). Table 1 summarises baseline characteristics. PFS in patients with NVR per surgeon report but target lesions by RECIST was between that in concordant surgically and radiologically assessed NVR and visible residuum subgroups (Table 2). Table 1. Baseline characteristics according to extent of residual disease



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Conclusions: These analyses suggest that in patients with radiologically detected target lesions despite NVR per surgeon report, prognosis may be worse than in those with NVR by both assessment methods. Postsurgical imaging may therefore add valuable prognostic information.



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IGCS-0665 OVARIAN CANCER Clear cell carcinoma of the ovary: poor outcome in advanced and recurrent disease F.C. Ku1, R. Wu2, L.Y. Yang3, Y.H. Tang1, W.Y. Chang3, J.E. Yang1, C.C. Wang4, S.M. Jun2, T.C. Chang1, A. Chao1, C.H. Lai1 1Chang Gung Memorial Hospital, Department of Obstetrics and Gynecology- Gynecologic Cancer Research Center, Taoyuan, Taiwan 2Chang Gung Memorial Hospital, Department of Pathology, Taoyuan, Taiwan 3Chang Gung Memorial Hospital, Biostatics Unit- Clinical Trial Center, Taoyuan, Taiwan 4Chang Gung Memorial Hospital, Department of Radiation Oncology, Taoyuan, Taiwan Background and Aims: Clear cell carcinomas (CCCs) of the ovary have distinct molecular and biological features among epithelial ovarian cancers (EOCs). We aimed to define the clinical pathological characteristics, treatment and outcome of ovarian CCC of the Taiwanese women and compare it to serous carcinoma (SC). Methods: The clinical-pathological data of all patients with stages I-IV EOCs receiving primary treatment at Chang Gung Memorial Hospital (CGMH) between 2000 and 2013 were retrospectively reviewed and analyzed. Results: A total of 897 EOC patients were eligible for analysis, of which 181 (20.2%) patients were diagnosed with CCC, and 360 (40.1%) with SCs, and 4 (0.4%) with mixed CCC/SCs. CCCs were diagnosed more commonly (67.4%) at stage I-II as compared to SCs (15.3%). Age, advanced FIGO stage, and residual tumor (> 1cm) were independent prognostic factor for stages I-IV CCC, while positive cytology was the sole poor prognostic factor for stage I by multivariate analysis. The 5-year overall survival (OS) of CCC was significantly worse compared to SCs for stage III (23.6% vs 47.9%, p < 0.001), and stage IV (0% vs 24.5%, p = 0.001), but not in stage I (85.5% vs 94.3%) or stage II (72.5% vs78.2%). 5-year survival after recurrence was significantly shorter for CCC than SC (14.2% vs 24.3%, p = 0.001). Conclusions: Researches to discover adverse molecular markers for stage IA CCCs can provide better selecting criteria for fertility-preserving treatment and to identify relevant targets for high-risk early-stage, advanced and recurrent CCCs are anticipated to improve the outcomes.



749

IGCS-0268 OVARIAN CANCER Expression of bone turnover markers in patients with tuboovarian carcinoma exposed to platinum-based chemotherapy ± bevacizumab C.M. Kurbacher1, A. Huhmann1, S. Herz1, A.T. Kurbacher1, K. Monreal1, J.A. Kurbacher2 1Gynecologic Center Bonn-Friedensplatz, Gynecologic Oncology, Bonn, Germany 2Gynecologic Center Bonn-Friedensplatz, General Gynecology and Obstetrics, Bonn, Germany Background and Aims: Data regarding direct effects of chemotherapy (Ctx) on the bone metabolism of patients (pts) with epithelial tuboovarian carcinoma (ETOC) are limited. This translational project sought to gain detailed information on the expression of various bone markers in ETOC pts exposed to platinum-based Ctx±bevacizumab (Bev). Methods: 85 ETOC pts were analyzed, 16 also received Bev. The following bone markers were determined prior to every Ctx cycle (C1-C6): C-terminal telopeptide of type I collagen (ICTP) measuring the osteoclast function, N-terminal propeptide of type I collagen (P1NP) measuring the osteoblast function, and alkaline phosphatase (AP). Results for C2-6 were expressed as percent of C1 values. Changes of bone markers over time were analyzed using repeated measures ANOVA with p0.05>0.10). Conclusions: Preliminary results suggest that a KD has a beneficial effect on BMI and lipid profile. Patients’ fasting glucose, insulin levels, and angiogenesis markers decreased. These results may be confounded by simultaneous treatment with chemotherapy. Increase in CRP may reflect the transition from carbohydrate to fat oxidation. Future work will include a randomized trial with these patients on chemotherapy with or without the KD.

IGCS-0214 OVARIAN CANCER



752

PHASE 3 TRIAL OF AVELUMAB (ANTI-PD-L1) IN COMBINATION WITH AND/OR FOLLOWING PLATINUM-BASED CHEMOTHERAPY IN PATIENTS WITH UNTREATED OVARIAN CANCER J. Ledermann1, K. Fujiwara2, I. Vergote3, A. Oza4, M. Birrer5, P. Disilvestro6, J.T. Beck7, L. Randall8, U. Matulonis9, M. Shnaidman10, H. Potier11, C.B. Mather12, A. Morozov11, B. Monk13 1UCL Cancer Institute, CR-UK & UCL Cancer Trials Centre, London, United Kingdom 2Saitama Medical University- International Medical Center, Department of Gynecologic Oncology, Yamane- Hidaka-city- Saitama, Japan 3KU Leuven, Department of Gynecologic Oncology, Leuven, Belgium 4Princess Margaret Cancer Centre, Cancer Clinical Research Unit CCRU, Toronto- Ontario, Canada 5Massachusetts General Hospital- Richard B. Simches Research Center, Center for Systems Biology, Boston- Massachusetts, USA 6Women & Infants Hospital, Department of Gynecologic Oncology, Providence- Rhode Island, USA 7Highlands Oncology Group, Department of Medical Oncology, Fayetteville- Arkansas, USA 8UC Irvine Health- Ovarian Cancer Center, Deprartment of Gynecologic Cancer, Orange- California, USA 9Dana-Farber Cancer Institute, Department of Gynecologic Oncology, Boston- Massachusetts, USA 10Pfizer Inc., Biostatistics, New York- New York, USA 11Pfizer Inc., Immuno-Oncology, New York- New York, USA 12Pfizer Inc., Immuno-Oncology, Groton- Connecticut, USA 13St. Joseph’s Hospital and Medical Center, Center for Women’s Health at Dignity Health, Phoenix- Arizona, USA Background and Aims: PD-L1 is a key therapeutic target in the reactivation of the immune response against cancer. Avelumab* (MSB0010718C) is a fully human anti-PD-L1 antibody that has shown promising efficacy and manageable safety in patients with advanced pre-treated ovarian cancer (OC). Chemotherapy has been shown to have immunostimulatory properties. JAVELIN Ovarian 100 (NCT02718417) is an open-label, multicenter, 3-arm trial evaluating avelumab in combination with and/or following first-line (1L) chemotherapy in patients with ovarian cancer. Methods: This trial investigates if avelumab administered in combination with and/or following 1L chemotherapy is superior to chemotherapy alone followed by observation. Eligibility criteria include: newly diagnosed stage III-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer following debulking surgery or prior to neoadjuvant chemotherapy, irrespective of PD-L1 status. Approximately 951 eligible patients will be randomized (1:1:1) to receive: (A) chemotherapy followed by observation; (B) chemotherapy followed by avelumab; or (C) chemotherapy + avelumab followed by avelumab. Chemotherapy backbone is carboplatin Q3W plus investigator’s choice of weekly paclitaxel (80 mg/m 2) or Q3W paclitaxel (175 mg/m2). Avelumab is administered at 10mg/kg Q3W with 1L chemotherapy. Patients in arms B or C who have not progressed after chemotherapy receive maintenance avelumab 10mg/kg Q2W for maximum of 24 months. Neoadjuvant patients in each arm will undergo interval debulking after 3 cycles. The primary endpoint is progression-free survival (PFS). Secondary endpoints include overall survival, PFS by Gynecological Cancer InterGroup criteria, maintenance PFS; pCR, PFS2, pharmacokinetics, immunogenicity, quality of life, safety, and biomarkers in tumor and blood. *Proposed INN. Results: N/A Conclusions: N/A



753

IGCS-0857 OVARIAN CANCER A CANCER UNIT'S EXPERIENCE AND OUTCOMES OF ADVANCED OVARIAN CANCER J. Lee1, A. Keightley1, S. Watmore1, M. Roche1, C. Gan1, J. Abu1 1City Hospital - Nottingham University Hospitals NHS Trust, Obstetrics and Gynaecology, Nottingham, United Kingdom Background and Aims: Ovarian cancers are usually diagnosed at the advanced stages with poor prognosis. Optimal debulking surgery and platinum-based chemotherapy are vital for treatment and improving prognosis. This audit was performed to review how these patients were managed in our unit and their outcomes. Methods: Patients with stage 3 and 4 ovarian cancer between January 2010 and December 2015 were identified from the chemotherapy database. Further data collection on histology, type of treatment given and recurrence were obtained from electronic notes on NOTIS. Results of survival and cause of death are currently awaited from the National Cancer Registry. Results: There were 340 patients with advanced ovarian cancer. The following is the interim analysis of 110 patients during this period. 62% of patients had Stage 3 and 38% had stage 4 ovarian cancer. Majority of patients (45%) had primary chemotherapy only, 23% had neoadjuvant chemotherapy, 16% had primary debulking surgery followed by chemotherapy, 16% had 6 cycles of chemotherapy followed by delayed debulking surgery and 2% could not tolerate any treatment. Of those who had surgery, 57% achieved complete cytoreduction, 20% had optimal and 23% and suboptimal debulking. The end of treatment CT scan showed 41% had complete response, 25% had partial response, 9% had stable disease and 10% had progressive disease. 57% had recurrence within the 6 years period. Conclusions: We found majority of our patients were treated with primary chemotherapy only because they were not fit for debulking surgery. Further results on survival and cause of death will be available.



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IGCS-0756 OVARIAN CANCER Prediction of a non-rising increase of serum CA-125 levels during chemotherapy treatment in recurrent patients of advanced epithelial ovarian cancer after reviously being treated optimally S.H. Lee1, H.J. Roh1, Y.S. Kwon1, S.J. Lee1, J.W. Ahn1 1Ulsan University Hospital, Division of Gynecologic Oncology, Ulsan, Republic of Korea Background and Aims: To evaluated the frequency with non-rising serum CA- 125 concentration with the normal range (0-35 KU/I) in spite of chemotherapy in recurrent patients of advanced epithelial ovarian cancer (adEOC) after previously being treated optimally Methods: A total of 146 patients (74 early ovarian cancer, 72 advanced ovarian cancer) surgically treated from 2001 to 2014 for epithelial ovarian cancer were retrospectively identified at ulsan university hospital. Inclusion criteria were as follows: CA-125 at time of diagnosis (>35 kU/l) ; International Federation of Gynecology and Obstetrics stages III–IV treated with optimal primary treatment; and complete response (CR) to primary treatment with normalization of CA-125 Results: 67/146 (46%) for recurrence group (n=67) had disease recurrence; 16/74(22%), 51/72(71%) for early EOC, adEOC(III-IIV), respectively. 11/51(22%) adEOC was non-rising increase of serum CA-125 levels during chemotherapy treatment. Sensitivity for adEOC was 78% a negative predictive value was 65%, and a false-negative rate was 21%.respectively Conclusions: Among recurrent patients of adEOC in complete remission after previously being treated optimally, nonrising serum CA-125 concentration is within the normal range. This fact supports that information about the drug response is limited in an actual treatment, therefore particular attention including radiologic imaging modality and newly sensitive diagnostic tool is necessary



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IGCS-0146 OVARIAN CANCER Expression of the c-MET protein in epithelial ovarian cancer and borderline ovarian tumor in Korean women M. Dong1, W.Y. Kim2, S.H. Shim1, S.J. Lee1 1Konkuk University Hospital- Konkuk University School of Medicine, Department of Obstetrics and Gynecology, Seoul, Republic of Korea 2Konkuk University Hospital- Konkuk University School of Medicine, Department of Pathology, Seoul, Republic of Korea Background and Aims: The aim of this study was to assess protein overexpression of c-MET in epithelial ovarian cancer and borderline ovarian tumor, and to assess its potential as a novel therapeutic target in Korean women. Methods: One hundred and five cases of epithelial ovarian cancer and 54 cases of borderline ovarian tumor were analyzed for c-MET protein overexpression by immunohistochemistry (IHC). All cases have been treated and followed up in single institute based on a community in Seoul, South Korea. Results: Protein overexpression was observed in 35 of 105 (33.3%) epithelial ovarian cancer cases, with IHC 2+ in 27 and IHC 3+ in 8. c-MET expressions of serous, mucinous, clear cell, and endometrioid adenocarcinomas were 14.3%, 83.3%, 65.0%, and 0%, respectively. c-MET overexpression was significant in mucinous adenocarcinoma (P < 0.001). c-MET expression was not correlated with overall survival of the patients (P = 0.932). Thirty-six of 54 (66.7%) borderline ovarian tumor cases overexpressed c-MET protein. C-MET expressions of serous, mucinous, and seromucinous borderline tumors were 15.4%, 71.5%, and 61.5%, respectively. c-MET overexpression was significant in mucinous borderline tumor (P = 0.012). Conclusions: In Korean women, mucinous adenocarcinoma and mucinous borderline tumors overexpressed c-MET protein significantly compared to other cell types. c-MET may serve as a therapeutic target for mucinous carcinoma and mucinous borderline tumor.



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IGCS-0696 OVARIAN CANCER Carcinosarcoma of the Ovary: Analysis of a Case Series Y.K. Lee1, C.H. Lee2, S.A. Kim1, K.A. So1, M.K. Kim1, K.H. Lee1, I.H. Lee1, T.J. Kim1, K.T. Lim1 1Cheil General Hospital, Obstetrics & Gynecology, Seoul, Republic of Korea 2Dongguk University, Obstetrics & Gynecology, Seoul, Republic of Korea Background and Aims: The ovarian carcinosarcoma is a very rare malignancy. The aim of this study was to determine the response rate, recurrence-free survival, and overall survival of patient with ovarian carcinosarcoma who were treated with various combination of chemotherapy. Methods: Between 2000 and 2015, 15 patients with histologically confirmed ovarian carcinosarcoma were identified for analysis at Cheil general hospital. Data were extracted from medical records and pathology records. Results: Patient age ranged from 29 to 73 years (mean: 51.4). Stage of each patient was as follows: 3, 2, 7, and 3 patients showed stage I, II, III, and IV, respectively. All patients underwent surgical resection and 11 were cytoreduced to less than 1cm. All patients received chemotherapy after surgery. Nine patients (60%) received carboplatin and paclitaxel, 2 (13%) received cisplatin and ifosfamide, 2 (13%) received cyclophosphamide, adriamycin and cisplatin, 1 (6%) received cisplatin and paclitaxel, 1 (6%) received paclitaxel, carboplatin and ifosfamide. The median disease-free survival was 28 months, median overall survival was 21.5 months. The one year overall survival rate was 40% and five year overall survival rate was 20%, respectively. Disease-free survival was better in optimal cytoreductive group (36.1 months vs. 14.3 months). Conclusions: Ovarian carcinosarcoma is a poor prognostic disease. Optimal debulking surgery appears to be of prognostic significance.



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IGCS-0701 OVARIAN CANCER Incidental Serous Tubal Intraepithelial Carcinoma in the Nonprophylactic Setting: Analysis of a Case Series K.A. So1, Y.K. Lee1, K.T. Lim1, M.K. Kim1, T.J. Kim1, K.H. Lee1, I.H. Lee1 1Cheil General Hospital, Obstetrics & Gynecology, Seoul, Republic of Korea Background and Aims: A precursor for invasive ovarian high-grade serous carcinoma, termed serous tubal intraepithelial carcinoma (STIC), has been identified and characterized through careful analysis of the fallopian tubes in both prophylactic salpingoo-ophorectomy specimens obtained from women with either a family history of breast and/or ovarian cancer or germline mutations of BRCA1 and BRCA2 and in cases of pelvic highgrade serous carcinoma. Data on incidental STICs are limited. Therefore, we analyzed clinicopathologic features STICs associated with epithelial ovarian cancer (EOC). Methods: Between 2012 and 2015, 5 STICs associated with EOCs identified incidentally in fallopian tubes removed for nonprophylactic indications at the Cheil General Hospital. The data were analyzed using SPSS software, version 17.0 (IBM, Chicago, IL, USA). Results: Patient age ranged from 43 to 60 years (median: 51), and only 2 patients experienced menopause. One patient was identified to carry BRCA1 mutations. All the 5 STICs were associated invasive high-grade ovarian serous carcinoma, and 3 were located in the fimbriated portion, and 2 were at the junction of the fimbria and infundibulum. The invasive components were in the fallopian tube in 4 cases, and the remaining 1 case had a high-grade serous carcinoma within the ipsilateral ovary without an associated invasive component in the fallopian tube. All of the patients underwent cytoreductive surgery and adjuvant chemotherapy without recurrence of disease. Conclusions: This study demonstrates that the potential for complete examination of the fallopian tubes and ovaries to identify STICs and early invasive serous carcinomas is also meaningful in Korea.



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IGCS-0382 OVARIAN CANCER ANGIOGENESIS IN PRIMARY AND METASTATIC OVARIAN CANCER: CHARACTERIZATION BY 3.0T DIFFUSION-WEIGHTED MRI A. Lehikoinen1, M. Anttila1,2, S. Rautiainen3, O. Raponen3, A. Kivelä4, K. Hämäläinen5,6, V.M. Kosma5,6,7, S. Ylä-Herttuala4, R. Vanninen3,7,8, H. Sallinen1,2,4 1Kuopio University Hospital, Gynaecology, Kuopio, Finland 2Institute of Clinical Medicine- School of Medicine, Gynaecology, Kuopio, Finland 3Kuopio University Hospital, Glinical radiology, Kuopio, Finland 4A.I.Virtanen Institute for Molecular Sciences, Department of Biotechnology and Molecular Medicine, Kuopio, Finland 5Kuopio University Hospital, Pathology and Forensic Medicine, Kuopio, Finland 6Institute of Clinical Medicine- School of Medicine, Pathology and Forensic Medicine, Kuopio, Finland 7Institute of Clinical Medicine- School of Medicine, Cancer Center of Eastern Finland, Kuopio, Finland 8Institute of Clinical Medicine- School of Medicine, Clinical Radiology, Kuopio, Finland Background and Aims: Prognosis of ovarian cancer (OC) remains still poor. We aimed to study whether apparent diffusion coefficients (ADCs) measured by 3.0T diffusion-weighted magnetic resonance imaging (DWI) are associated with angiogenesis in ovarian cancer (OC) or predict the clinical course in patients. Methods: We prospectively enrolled 40 patients with primary OC treated at Kuopio University Hospital in 20112014. DWI-MRI was performed with a 3.0T imaging system prior to surgical treatment. Two observers used the following regions of interest (ROIs) to analyze ADCs: whole primary lesion ROI (W-ROI) and five small ROIs (mean of two lowest ADCs; S-ROI). Tissue samples from tumors and metastases were collected during surgery. Immunohistochemistry and quantitative reverse transcription polymerase chain reaction (qRT-PCR) analyses were used to measure the expression of vascular endothelial growth factor (VEGF) and its receptors. Results: The interobserver reproducibility of ADC measurements was excellent for primary tumors (ICC 0.912 for W-ROI, 0.868 for S-ROI). Low ADCs values were significantly associated with poorly differentiated OC (W-ROI p=0.022; S-ROIs p=0.028). In primary tumors, lower ADCs were significantly associated with high Ki-67 (both p=0.027) and low VEGF expression (both p=0.043). In metastases, lower ADCs (W-ROI) significantly correlated with low VEGF receptors mRNA levels: VEGF-R1 (p=0.001), VEGF-R2 (p=0.006) and VEGF-R3 (p=0.039), and also with low VEGF-C (p=0.038). ADCs also had a predictive value; 3-year overall survival was poorer in patients with lower ADCs (W-ROI p=0.020, S-ROI p=0.042). Conclusions: DWI is a valuable tool for characterizing OC and assessing angiogenesis and survival in patients with OC.



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IGCS-0044 OVARIAN CANCER Identifing the Differentially Expressed Proteins in Taxol Resistant Ovarian Cancer Samples H. Li1 1Beijing Shijitan Hospital - Capital Medical University, O&G, Beijing, China Background and Aims: To identified the differentially expressed proteins in taxol resistance samples of ovarian cancer. Methods: The reserch was done between the 2 groups of taxol resistance and taxol sensitive samples of ovarian cancer by applicating iTRAQ labeling combined LC-MS/MS technology. The 4 different expression proteins including SART1, TKTL1,CD146,and HE4 were then analyzed further in 67cases of ovarian cancer tissue samples by using western blotting test. Results: 1. Total of 496 differentially expressed proteins were identified., up-regulated proteins were 263 and down-regulated proteins were 233. 2. Differentially expressed proteins were involved in neuroactive ligand-receptor interaction, systemic lupus erythematosus, glycine, serine and threonine metabolism, complement and coagulation cascades, spliceosome, salivary secretion, methane metabolism, pentose phosphate pathway, lysosome pathways. 3. Western blotting assay found that there were significant differences of SART1, TKTL1, CD146 and HE4 protein expressions between taxol sensitive protein group and resistance group in ovarian cancer tissues.,consistent with the proteomic iTRAQ results. 4.The advanced stage (III) ovarian cancer showed higher SART1, TKTL1, CD146 and HE4 protein expressions level than early-stage (I/II) (P = 30 kg/m2 (adjusted odds ratio [aOR], 3.07; 95% confidence interval [95%CI], 1.0-9.6) ,CA125 > 100 IU/L (aOR, 3,99; 95%CI, 1.6-10.1), diaphragmatic and /or omental carcinomatosis by CT-Scan (aOR, 5.82; 95%CI, 2.6-13.1), and positive parenchymal metastases by PET/CT (aOR, 3,59; 95%CI, 1.0-12.8). The 100-point score was based on these criteria. The area-under-the-curve of the score was 0.80 (95%CI, 0.72-0.86). In the validation group, no patient ranked in the high risk group of incomplete cytoreductive surgery had a primary complete surgery (95% CI 0 -16). 10,3% of patients for whom primary complete cytoreduction was not possible, had been classified in the group at low risk of incomplete cytoreductive surgery (3/29; 95% CI 4-27). Conclusions: This pre-operative score may prove useful for triaging patients who may have complete cytoreductive surgery from those who will have neoadjuvant chemotherapy, while avoiding some unnecessary laparoscopy.



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IGCS-0481 OVARIAN CANCER Early mucinous ovarian cancers: is lymphadenectomy needed? F. Martinelli1, A. Ditto1, G. Bogani1, M. Signorelli1, V. Chiappa1, G. Maltese1, S. Lepori1, D. Lorusso1, F. Raspagliesi1 1Fondazione IRCCS Istituto Nazionale dei Tumori, Gynecologic Oncology, Milano, Italy Background and Aims: To evaluate the prevalence of nodal involvement in mucinous-ovarian-cancers (mOCs). To compare recurrence rates and survival outcomes between patients submitted or not to lymphadenectomy (LNX). Methods: Retrospective evaluation of patients underwent a surgical-staging (SS) for apparent early-stage-mOC (FIGO stage I-II). SS was performed according to FIGO guidelines. Only primary pure mOCs were evaluated. Demographics, surgical procedures, adjuvant treatments, were analyzed. DFS, cause-specificsurvival (CSS) and OS curves were estimated with the Kaplan–Meier method. Comparisons were performed with log-rank-test. Results: Among 109 pure mOCs, LNX was performed in 73 patients (67%). Mean age was 43.9 years (2078). The 98.2% presented apparent stage I disease. 17 patients (15.6%) were upstaged after surgery and 35 women (32.1%) received adjuvant chemotherapy. Only one case of nodal involvement was found (0.9%). After a mean follow-up of 317 months (95%CI:301-333 months) there were 8 relapses (7.3%), 11 patients died (10%) and among these, 5 patients died-of-disease (4.6%). No statistical differences in terms of DFS p:0.344, CSS p:0.730 and OS p:0.527 in respect to LNX vs no-LNX were found (Table).

Conclusions: Incidence of nodal metastases in early-stage-mOCs is extremely low, in concordance with literature data. Our data suggest that omitting LNX is as safe as performing a full staging in terms of OS, CSS and DFS. Undoubtedly a full peritoneal staging needs to be performed being the risk to miss a major spread of disease up to 15%, but the omission of LNX could be pursued in pure mOCs.



769

IGCS-0484 OVARIAN CANCER Fertility sparing surgery in early stage mucinous ovarian cancers F. Martinelli1, A. Ditto1, G. Bogani1, M. Signorelli1, V. Chiappa1, C. Scaffa1, D. Recalcati1, G. Maltese1, S. Lepori1, D. Lorusso1, F. Raspagliesi1 1Fondazione IRCCS Istituto Nazionale dei Tumori, Gynecologic Oncology, Milano, Italy Background and Aims: Fertility-Sparing (FS) treatments are gaining popularity in recent years. We evaluated the safety of a FS surgical-staging (SS) in patients with primary mucinous-ovarian-cancers (mOCs). Comparisons with radical-SS (RSS) were performed. Methods: Retrospective evaluation of patients with apparent early-stage-mOCs (FIGO stage I-II). FS consisted in sparing of an ovary and uterus. SS was performed according to FIGO guidelines. Only primary pure mOCs where evaluated. Demographics, surgical procedures, adjuvant treatments, were analyzed. DFS, cause-specific-survival (CSS) and OS curves were estimated with the Kaplan–Meier method. Comparisons were performed with log-rank-test. Results: Globally 109 pure mOCs were retrieved. Mean age was 43.9 years (20-78). Only 38 patients (34.9%) were in menopause. The 98.2% presented apparent stage I disease. In 37 women FS was performed (33.9%). 17 patients (15.6%) were upstaged after surgery; and 35 women (32.1%) received adjuvant chemotherapy. After a mean follow-up of 317 months (95%CI:301-333 months) there were 8 relapses (7.3%), 11 patients died (10%) and among these, 5 patients died-of-disease (4.6%). No statistical differences in terms: DFS p:0.944, CSS p:0.804, OS p:0.427 were found in respect to FS vs RSS (Table).

Conclusions: In concordance with literature our data suggest that FS-SS has comparable results to a RSS in term of OS, CSS and DFS in mOCs. Undoubtedly a full peritoneal staging has to be performed being the risk to miss a major spread of disease up to 15%, but a FS approach could be offered in pure mOCs.



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IGCS-0539 OVARIAN CANCER OLAPARIB AS MAINTENANCE THERAPY AFTER PLATINUM-SENSITIVE RELAPSED OVARIAN CANCER (PS-ROC). LATIN AMERICAN EXPERIENCE A.L. Mendaña1, G. Giornelli1, M. Chacon1, M.V. Costanzo1, C.S. Puparelli1, F. Petracci1, L. Bruno1, M.L. Casalnuovo2, G. Lerzo2, G.J. Recondo3, G. Recondo3, M. Tamburelli4 1Alexander Fleming, Clinical Oncology, Capital Federal, Argentina 2Hospital Maria Curie, Clinical Oncology, Capital Federal, Argentina 3Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" CEMIC, Clinical Oncology, Capital Federal, Argentina 4Hospital Alemán, Clinical Oncology, Capital Federal, Argentina Background and Aims: Homologous recombination deficiency is considered to be present in up to 50% of Ovarian Cancer (OC) patients (pts), which makes it sensitive to PARP inhibitors. Olaparib has been approved as maintenance therapy after PS-ROC in many countries. Our aim is to report the results of this indication in Argentina as part of the Olaparib Named Patient Supply Program (NPS), so far the only Latin American experience with this drug. Methods: We evaluated retrospectively pts with mutated BRCA 1/2 PS-ROC, treated with Olaparib as maintenance therapy after having achieved response to a platinum-based combination as part of the NPS from four Argentine hospitals, from July/2015 to April/2016. Results: 14 pts were included. Median age was 58 years (r42-70). Number of relapse before Olaparib: 1st n: 4 (28%), 2nd n: 4 (28%), >2nd n: 6 (44%). Median duration of treatment: 5 months (m) (r1-14). Most frequent toxicities were: Anemia Grade (G) 1-2: 6(43%), G3-4: 2(14%);; Neutropenia G1-2: 1(7%), G3-4: 2(14%); Trombocitopenia G1-2: 2(14%), no G3-4; Fatigue G1-2: 5(36%), G3-4: 1(7%) Nausea-vomiting G1-2: 2(14%), no G3-4; Diarrhea G1-2 2(14%), no G3-4. 4 pts (29%) had dose reduction due to toxicity. After a median follow-up of 7 m (r1-16), 6 pts (43%) discontinued treatment for disease progression and none due to toxicity. Progression free interval was 6 m (r1-10). Conclusions: Olaparib maintenance therapy is well tolerated. Toxicities were similar to the ones reported in pivotal trials. Olaparib approval by local regulatory authorities is pending in our country.



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IGCS-0200 OVARIAN CANCER A SUCCESSFUL PREGNANCY AFTER TWO FERTILITY-SPARING SURGERIES FOR BORDERLINE OVARIAN TUMOR E. Espino-Strebel1, P.A. Mendiola1, M. Manabat1 1San Juan de Dios Educational Foundation- Inc., Department of Obstetrics and Gynecology, Pasay City, Philippines Background and Aims: Serous borderline tumors are the most common subtypes of non-benign serous tumors in the young, usually confined to one or both ovaries. To preserve ovarian function and fertility, conservative management can be performed. Although recurrence is higher than that after completion surgery, the rate of recurrences after fertility-sparing surgery continues to be debated. Most recurrent diseases have the same histopathology as the initial tumor, and adequate excision of the recurrent tumor can be done. Pregnancies have been reported in patients with conservatively managed borderline ovarian tumors (BOTs). No definite association of disease recurrence during pregnancy had been established. This report aims to present a case of successful pregnancy after two fertility-sparing surgeries for BOT, with the patient being free of disease at the time of delivery. Methods: A 26-year old nulligravid underwent bilateral oophorocystectomy and complete surgical staging procedure for a stage IB serous borderline ovarian tumor. Three years later, she developed tumor recurrence, for which another fertility-sparing surgery consisting of left salpingooophorectomy and contralateral oophorocystectomy was done. Results: Histopathology was consistent with a recurrent BOT. Two years after the second surgery, the patient had a spontaneous pregnancy and delivered a live term healthy baby. Examination of the pelvic organs at the time of Cesarean section for intrauterine infection was normal. Conclusions: Routine removal of the remaining ovary and completion surgery remains to be controversial, but would be unnecessary in majority of patients. The case presented underlines the fact that conservative surgeries are feasible for BOTs, with subsequent good obstetric and oncologic outcomes.



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IGCS-0532 OVARIAN CANCER EXPRESSION OF HOX GENES IN OVARIAN CANCER CELLS M.S. Kim1, J.Y. Choi1, S. Lee1, S.M. Yun1, D.H. Suh1, K. Kim1, J.H. No1, Y.B. Kim1, S.B. Kang2, H.P. Lee3 1Seoul National University Bundang Hospital, Department of Obstetrics and Gynecology, Seongnam si- Gyounggi-do, Republic of Korea 2Konkuk University Medical Center- Konkuk University School of Medicine, Department of Obstetrics and Gynecology, Seoul, Republic of Korea 3Soon Chun Hyang University Hospital, Department of Obstetrics and Gynecology, Seoul, Republic of Korea Background and Aims: To explore the expression pattern of HOX and response to cisplatin in various types of ovarian cancer cells. Methods: Expression pattern of eleven HOX (HOXA4, A7, A9, A10, A11, A13, B4, B7, B9, B13, and D10) in eight ovarian cancer cell lines of different histologic types were analyzed by western blot: serous (OV-90, OVCAR-3, SKOV-3, and Ca-OV3), endometrioid (ES-2 and TOV-21), and mucinous (MCAS and RMUGS). The ratios of expression levels of HOX to those of positive control were calculated for comparing relative intensities in different cell lines. We also evaluated the change of HOX expression after treatment of 10μM cisplatin for 48 hours in serous and mucinous type ovarian cancer cells. Results: There was no histology-specific expression pattern of HOX in the eight ovarian cancer cell lines (figure 1). In cell lines with the same histologic type, the level of expression of most HOX genes were different. By contrast, HOXA9 and A13 were evenly expressed in all cell lines with the ratio being around 1.0 and >1.5, respectively. Of note, HOXB4 showed relatively specific expression: high and scant expression in SKOV3 in RMUG-S, respectively. After treatment of cisplatin, heterogeneous levels of decrease of HOX expression were found in serous type cell lines, however, only HOXA7 showed significant decrease of expression. Conclusions: Expression of HOX in ovarian cancer cell lines were heterogeneous. Our findings of specific expression pattern of HOXB4 and response of HOXA7 to cisplatin suggest that the two HOX genes could be targets of histology-specific treatment of ovarian cancer.



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IGCS-1068 OVARIAN CANCER Circulating Tumor Cell: a Potential Indicator for Reduction of Intraperitoneal Tumor Burden in Ovarian Cancer M. Kim1, D.H. Suh1, J. Bu2, Y.T. Kang2, K. Kim1, J.H. No1, Y.B. Kim1, Y.H. Cho2 1Seoul National University Bundang Hospital, Department of Obstetrics and Gynecology, Seongnam, Republic of Korea 2Korea Advanced Institute of Science and Technology KAIST, Department of Bio and Brain Engineering, Daejeon, Republic of Korea Background and Aims: To evaluate an impact of primary cytoreductive surgery on circulating tumor cell (CTC) in patients with ovarian cancer. Methods: The number of CTC in each 5 ml of peripheral blood before (B1) and after (B2) primary cytoreductive surgery in 25 women with ovarian cancer was counted using the same CTC detecting platform. Mean CTC counts from two blood samples, B1 and B2, were compared using a paired t-test in different clinicopathologic conditions. Results: Median age was 59 years (range 24-77 years). Twenty (75%) underwent complete resection with no residual tumor. Nine (36%) omental metastasis and nine (36%) moderate-to-severe ascites were observed. All nine with ascites had no residual tumor. Neither preoperative (B1) nor postoperative (B2) CTC count was not correlated with any clinicopathologic characteristics including serum CA-125, risk of ovarian malignancy algorithm (ROMA), tumor size, histologic type, stage, omental or lymph node metastasis, ascites, and residual tumor. Significant decrease of the mean CTC number between B1 and B2 was shown in patients who had no residual tumor after surgery (5.79±9.05 vs. 1.42±2.57, p=0.029), omental metastasis (3.63±3.58 vs. 0.63±0.74, p=0.044) and ascites (2.56±2.70 vs. 0.67±0.71, p=0.047). However, significant decrease of mean CTC number was not observed in patients with gross residual tumor, no omental metastasis and no ascites. Conclusions: Our findings suggest that deburdening impact of complete resection with no residual tumor might be reflected in CTC count in ovarian cancer patients, especially in the condition of great intraperitoneal tumor burden with omental metastasis as well as ascites.



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IGCS-1168 OVARIAN CANCER Audit of trabectedin use in high grade serous carcinoma S. Tahir1 1Broomfield Hospital, Oncology, Chelmsford, United Kingdom Background and Aims: Background: We conducted a retrospective audit looking at the effectiveness of trabectedin in high grade serous carcinoma as a single agent and in combination with pegylated doxorubicin (PLD). All patients received at least three line of chemotherapy. Trabectedin plus PLD was given second line in two patients, third line in two patients and fourth line in two patients. Methods: Retrospective audit of patient records. Results: One patients received two cycles, four patients received six cycles; and one patient received fifteen cycles. One patient progressed after two cycles, one patient mixed response, good in abdomen but new lung metastasis, one patient showed radiological stable disease, but with CA-125 response. Three patients showed CA-125 and radiological response. Duration of survival was 14 months, 18 months, 30 months, 30 months, 38 months, 9 years and 15 years. The most common adverse events reported was fatigue and sepsis. Conclusions: Conclusions: Trabectedin is an effective drug in combination with PLD for patients with previous response to platinum combination even with short progression free interval. Trabectedin has manageable toxicity profile.



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IGCS-0666 OVARIAN CANCER THE VALUE OF LIVER RESECTION AT PRIMARY, SECONDARY OR TERTIARY CYTOREDUCTIVE SURGERY FOR OVARIAN CANCER M. Kerem1, S. Yildiz Oguz2, E. Bostanci3, S. Misirlioglu2, F. Karatas3, K. Dikmen1, A. Alper4, M. Arvas5, H. Guner3, A. Onan3, C. Taskiran2 1Gazi University School of Medicine- Ankara- Turkey, Department of General Surgery, Ankara, Turkey 2VKF Koc University School of Medicine- Istanbul- Turkey, Department of Obstetrics and Gynecology, Istanbul, Turkey 3Gazi University School of Medicine- Ankara- Turkey, Department of Obstetrics and Gynecology, Ankara, Turkey 4VKF Koc University School of Medicine- Istanbul- Turkey, Department of General Surgery, Istanbul, Turkey 5VKF American Hospital- Istanbul- Turkey, Department of Obstetrics and Gynecology, Istanbul, Turkey Background and Aims: The purpose of this study was to evaluate the role of liver resection as a part of primary, secondary or tertiary cytoreductive surgery (CRS) Methods: The patients who underwent liver resection as a part of primary, secondary or tertiary CRS for ovarian cancer at Gazi and Koc University Hospitals between 2006 and 2015 were reviewed. Data retrieved from the special gynecologic oncology records, and surgico-pathological electronical database Results: A total of 47 patients were analyzed with a median age of 57 years. The resection was performed at primary cytoreduction in 21 patients (45%), at secondary in 21(45%), and at tertiary in 5 patients (10%). One patient had left hepatectomy, 1 had right hepatectomy, 2 had partial hepatectomy, 2 had caudate lobectomy, 19 had unisegmentectomy, 3 had multiplsegmentectomy, and 19 had metastasectomy. Although hepatectomy is performed in tumour recurrence, metastasectomy and segmentectomy rates are similar in primary and secondary cytoreductive surgery. To achieve optimal cytoreduction additional surgeries were performed besides to liver resection: bowel resection in 24, splenectomy in 11, diaphragmatic resection in 11, distal pancreatectomy in 2, cholecystectomy in 7, and partial gastric resection in 2 patients. Estimated blood loss was 400 mL (100-1200). No patient had morbidity except for one subhepatic abscess. Intraoperative and postoperative minor or major complication rates were not different between primary and recurrent cytoreduction groups. The median overall survival after liver resection was 38 months(2-120). Conclusions: Liver resections are safe and applicable procedures when it is performed by experienced surgeons in specialized dedicated oncological centers.



776

IGCS-0673 OVARIAN CANCER THE ROLE OF PROTECTIVE ILEOSTOMY AND THE VALIDITY OF BOWEL RESECTION AS A PART OF CYTOREDUCTIVE SURGERY FOR ADVANCED STAGE EPITHELIAL OVARIAN CANCER S. Misirlioglu1, C. Taskiran1, A. Onan2, F. Karatas2, S. Yildiz Oguz1, I. Guler2, E. Bostanci2, A. Bedirli3, M. Kerem3, E. Balik4, M. Arvas5, H. Guner2 1VKF Koc University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey 2Gazi University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey 3Gazi University School of Medicine, Department of General Surgery, Ankara, Turkey 4VKF Koc University School of Medicine, Department of General Surgery, Istanbul, Turkey 5VKF American Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey Background and Aims: The purpose of this study was to determine the impact of bowel resection at the time of cytoreductive surgery (CRS) for advanced stage eptihelial ovarian cancer Methods: A total of 153 patients who underwent bowel resection between 2004 and 2014 at Gazi University, VKF Koc University and American Hospital were reviewed retrospectively. Results: One-hundred and twenty nine of them underwent bowel resection at the time of primary CRS, and 24 patients were treated for recurrent ovarian carcinoma. Median age was 55 years. Of these patients, 73(48%) had rectosigmoid resection, 6(4%) had left hemicolectomy, 22(15%) had right hemicolectomy, 25(16%) had total colectomy,12(8%) had subtotal colectomy, 4(3%) had transverse colectomy, and the remaining 4(3%) had right hemicolectomy plus rectosigmoid resection simultaneously. To achieve optimal cytoreduction several surgeries were also performed in addition to bowel resection: splenectomy in 14, partial gastric resection in 7, distal pancreatectomy in 7, cholecystectomy in 10, portal and celiac lymph node dissection in 15, liver resection in 24, and diaphragmatic resection in 23 patients. Ileostomy and colostomy procedures were carried out for 34 and 9 patients, respectively. Anastomotic leak was detected in 5 patients; one of them was treated with conservative management. Three patients died within the postoperative thirty days. Conclusions: Aggressive CRS including bowel resection was associated with reliable mortality and morbidity rates. The value of protective ileostomy is not significant in this setting, and further analysis need to assess the possible role of this procedure in a subgroup of total colectomy and two or more anastomoses.



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IGCS-0677 OVARIAN CANCER DOES SCORING SYSTEMS REALLY PREDICT RESECTABILITY OR SHOULD WE DEFINE NEW ALGORITHM FOR ADVANCED STAGE EPITHELIAL OVARIAN CANCER C. Taskiran1, S. Misirlioglu1, S. Yildiz Oguz1, F. Karatas2, E. Bostanci2, M. Kerem3, E. Balik4, M. Arvas5, H. Guner2 1VKF Koc University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey 2Gazi University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey 3Gazi University School of Medicine, Department of General Surgery, Ankara, Turkey 4VKF Koc University School of Medicine, Department of General Surgery, Istanbul, Turkey 5VKF American Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey Background and Aims: The purpose of this study was to develop a new algorithm for the surgical treatment of advanced stage epithelial ovarian cancer. Methods: The patients who underwent cytoreductive surgery for AEOC at Gazi University and VKF Koc University Hospitals between 2010 and 2015 were enrolled. The prospective data was retrieved from the special gynecologic oncology records. Optimal and maximal cytoreduction were defined as residual tumour less than 1 cm, and no visible residual tumour, respectively. Carcinomatosis on small bowel serosa and involvement of mesenteric root were considered as an absolute criteria of unresectability. Results: A total of 92 Stage IIIC-IV patients were included. The median age was 56 years. As additional surgical procedures had 50 bowel resection, 10 total peritonectomy, 30 pelvic peritonectomy, 12 splenectomy, 7 partial gastric resection, 4 distal pancreatectomy, 9 portal and celiac lymph node dissection, 18 liver resection, 25 diaphragmatic resection and 5 cholecystectomy. In optimal group no more than 5 mm residual. 12 patient received neoadjuvant chemotherapy in this cohort because of age, co-morbidity, serous small bowel/mesenteric root involvement. One patient died to related surgical mortality within 30 days post-operatively and measured morbidity rate was 32%. Maximal and optimal debulking rate were 85% and 93%, respectively. Conclusions: No patients were unresectable because of their characteristics. The unresectable patients had severe retrohepatic or periportal disease necessitating whipple procedures or unexpected small bowel/mesenteric root involvement besides bleeding. Therefore, if the age, performance status, general health conveyed for major surgery, severe small bowel/mesenteric root involvements can be recruited neoadjuvant chemotherapy by laparoscopy.



778

IGCS-0687 OVARIAN CANCER FEASIBILITY AND LONG TERM SURVIVAL EFFECT OF TOTAL ABDOMINAL COLECTOMY AT THE TIME OF PRIMARY CYTOREDUCTION FOR ADVANCED STAGE EPITHELIAL OVARIAN CANCER C. Taskiran1, A. Onan2, S. Yildiz Oguz1, S. Misirlioglu1, E. Bostanci2, F. Karatas2, H. Bostanci3, A. Bedirli3, M. Kerem3, H. Guner2 1VKF Koc University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey 2Gazi University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey 3Gazi University School of Medicine, Department of General Surgery, Ankara, Turkey Background and Aims: The aim of this study was to assess the feasibility and survival benefit of total abdominal colectomy (TAC) performed during primary cytoreductive surgery (CRS) for advanced stage epithelial ovarian cancer (AEOC) without neoadjuvant chemotherapy. Methods: A total of 21 patients were evaluated who underwent TAC during the primary CRS for AEOC at Gazi University Hospital, between 2004 and 2014, were included to this study.

Results: Median age was 58 years (40-80). To achieve optimal cytoreduction several surgeries were also performed in addition to TAC: splenectomy in 6 patients (30%), partial gastric resection in 4(20%), distal pancreatectomy in 3(15%), cholecystectomy in 3(15%), liver resection in 2(10%), and diaphragmatic resection in 2(10%). Ileorectal or –anal anastomeses were performed with diverting ileostomies except for 4 patients. Anastomoses were end to end for 18 patients, side to end for 2, and J-pouch for the remaining one patient. Only 1 patient had anastomotic leak which was treated succesfully with conservative management. Post-operative major complication that needs to re-exploration was not observed in the first year, frequency of defecation decreased to 4 times a day and during this period fecal incontinance was not seen. One patient suffered from severe diahrrea, and effective stabilization was provided by medical treatment and specific diet within 6 months. The 5-year overall survival was %32, and five patients are still alive for 20, 54, 60, 78, and 84 months Conclusions: This study is one of the largest series evaluating the morbidity and long-term survival effect for AEOC with reliable morbidity and mortality rates



779

IGCS-0690 OVARIAN CANCER HOW CAN OPTIMAL CYTOREDUCTION RATES INCREASED OVER NINETY PERCENT WITH A MINIMAL USAGE OF NEOADJUVANT CHEMOTHERAPY ? C. Taskiran1, S. Misirlioglu1, A. Onan2, S. Yildiz Oguz1, F. Karatas2, E. Bostanci2, M. Kerem3, E. Balik4, A. Alper4, M. Arvas5, H. Guner2 1VKF Koc University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey 2Gazi University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey 3Gazi University School of Medicine, Department of General Surgery, Ankara, Turkey 4VKF Koc University School of Medicine, Department of General Surgery, Istanbul, Turkey 5VKF American Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey Background and Aims: The aim of this study is to share how maximal and optimal cytoreduction rates have reached approximately 80% and 90% respectively at a tertiary referral center with a minimal usage of neoadjuvant chemotherapy (NACT) Methods: Between 1995 and 2003 (group 1), even bowel resection was rarely performed as a part of cytoreductive surgery. During the following 5 years (2004-2007; group 2), bowel performed as a part of cytoreductive surgery. During the following 5 years (2004-2007; group 2), bowel resection was routinely performed when indicated along with upper abdominal debulking procedures. Standard approach for patients were changed after 2008 to do resection of every possible lesion by the help of general, thoracic, and vascular surgeons if it is needed (2008-2013; group 3). Optimal and maximal cytoreduction were defined as residual tumour less than 1 cm, and no visible residual tumour, respectively Results: A total of advanced stage epithelial ovarian cancer patients were included in the study. Mean age was 56. Patients were evaluated in 3 groups according to their year of treatment, as namely group 1 (85 patients), group 2 (103 patients), and group 3 (120 patients). Optimal cytoreduction rates were 62,83,91 and maximal cytoreduction rates were unrecorded, 65, and 82, respectively. Twenty-seven (9%) patients received NACT.Overall surgical mortality rate 2% and measured morbidity rate was 35% Conclusions: When performance status, co-morbidity and age of the patients are favorable; and if appropriate multiorgan resections were performed; very high levels of maximal and optimal cytoreduction were achieved, with acceptable morbidity and mortality rates



780

IGCS-0813 OVARIAN CANCER ROBOTIC APPROACH FOR THE PRIMARY TUBAL CARCINOMA METASTİZED IN THE PARAAORTIC LYMPH NODES AND MANAGEMENT OF ITS METASTATIC DISEASE BY ROBOTIC MEDIASTINAL LYMPHADENECTOMY S. Misirlioglu1, F. Gucer2, N. Ceydeli2, A. Kir3 1VKF Koc University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey 2Anadolu Medical Center- Istanbul- Turkey, Department of Obstetrics and Gynecology, Istanbul, Turkey 3Anadolu Medical Center- Istanbul- Turkey, Department of Thoracic Surgery, Istanbul, Turkey Background and Aims: 15.0 Normal 0 false false false TR JA X-NONE The aim of this case report is to present our experience in a patient with primary tubal carcinoma metastazing to the para-aortic lymph nodes who developed after two years recurrent disease in mediastinal lymph nodes following primary surgery and treated by robotic mediastinal lymph node dissection. To our best knowledge, this is the first case report treated by robotic approach either at the first presentation and or metastatic disease by robotic surgery. Methods: 15.0 Normal 0 false false false TR JA X-NONE A 57-year-old woman was admitted because of persistently slightly elevated CA 125 levels over 3 months. The patient underwent robotic total hysterectomy and bilateral salpingo-oophorectomy. Frozen section showed primary tubal serous adenocarcinoma. Also the patient underwent robotic systematic pelvic and para-aortic lymph adenectomy and infracolic omentectomy. Histopathological examination revealed metastases in 3 out of 17 para-aortic lymph nodes and no metastasis in the 24 pelvic lymph nodes or omental tissue. Following six cycles of adjuvant chemotherapy consisted of paclitaxel plus carboplatin, she achieved a complete clinical response. 26 months after the first treatment, CA 125 was elevated above normal level and thorax computed tomography showed metastatic disease in mediastinal lymph nodes. Robotic mediastinal lymph node resection was performed and metastatic adenocarcinoma was detected in three lymph nodes. Thereafter, the patient received six cycles of paclitaxel plus carboplatin as in the primary treatment. Results: 15.0 Normal 0 false false false TR JA X-NONE She is still in follow-up at outpatient clinic with 26 months therapy-free interval after secondary cytoreductive surgery. Conclusions: 15.0 Normal 0 false false false TR JA X-NONE Robotic approach may be a reasonable option for secondary debulking in selected patients with isolated mediastinal metastasis.



781

IGCS-0991 OVARIAN CANCER Pure dysgerminoma of the ovary: a single institutional experience of 29 patients H. Salhi1, B. Laamouri1, M. Chemlali1, M. Ghalleb1, M. Rezgani1, N. Boujelbene2, J. Ben Hassouna1, T. Dhiab1, M. Hechiche1, K. Rahal1 1Salah Azaiez, surgical oncology, Tunis, Tunisia 2Salah Azaiez, pathology, tunis, Tunisia Background and Aims: Germ cell tumors (GCTs) are rare, comprising approximately 20% of all ovarian tumors. Approximately 3 to 5% of ovarian GCTs are malignant. The most commonly occurring GCT is the dygerminoma, which accounts for approximately 2% of all ovarian cancers. The aim of this study is to investigate the clinical features and to evaluate treatment and factors related to prognosis of ovarian dygerminoma. Methods: The data of 29 patients with pure ovarian dysgerminoma who were treated in our institute between 1970 and 2012, were analyzed retrospectively. Results: The median age was 23years (range 11 –61). The main clinical features were 20 abdominal mass (69.9%), 14 abdominal swelling (48.8%), 10 abdominal pain (34.4%). 13patients had stage I diseases, 1 stage II, 13 Stage III, 2 stage IV. In the group of stage I, 10 patients received conservative surgery and 3 patients underwent radical surgery. As far as the adjuvant treatment, 16 patients received chemotherapy, and 11 patients received radiation therapy. The median follow-up period was74 months (range 7 – 182). There were two cases of recurrence. The median time to relapse was 14 months (range: 4 –20). There were two cases of distant metastasis. The 5-year overall and disease-free survivals were 89% and 74%, respectively. Conclusions: The prognosis of ovarian dysgerminoma is closely related to disease stage and modality of treatment. Fertility preservation operation should be considered in early-staged young patients.



782

IGCS-1019 OVARIAN CANCER Immature teratoma: A study of 27 cases H. Salhi1, B. Laamouri1, M. Chemlali1, N. Boujelbene2, M. Ghalleb1, J. Ben Hassouna1, T. Dhiab1, M. Hechiche1, K. Rahal1 1Salah Azaiez, surgical oncology, Tunis, Tunisia 2Salah Azaiez, pathology, tunis, Tunisia Background and Aims: Immature teratoma of the ovary represents 1% of all ovarian cancers and 20% of malignant ovarian germ cell tumors. We aim in this study to look at the morphological spectrum of these tumors and to study the correlation of the grade and stage of the tumor with prognosis. Methods: A retrospective study of 27 cases of immature teratoma of the ovary treated in Salah Azaiez institute between 1971 and 2012. Results: The median age for the cases was 26.1 years (range 16 to 39). Abdominal pain was the commonest symptom. Eighteen patients underwent conservative surgery and 9 patients underwent radical surgery. Eighteen patients had stage I diseases, 7 stage III, and 2 stage IV. Fifteen cases were grade I, 4 were grade II, and 8 were grade III. Thirteen patients had adjuvant chemotherapy. The follow up median was 97 months ranging from 9 months to 256 months. Twenty five patients were alive without evidence of disease recurrence. A local recurrence occurred in one patient who had stage IV disease and one patient who had stage III disease died after 3 months from the disease onset. Conclusions: Morphological spectrum of immature teratoma of ovary is varied. Stage I immature teratoma of the ovary has better prognosis. Combination of surgery and chemotherapy can give longer survival even in recurrent disease.



783

IGCS-0883 OVARIAN CANCER SAFETY AND EFFICACY OF NIRAPARIB IN PATIENTS WITH ADVANCED, RELAPSED, HIGHGRADE SEROUS EPITHELIAL OVARIAN, FALLOPIAN TUBE, OR PRIMARY PERITONEAL CANCER (QUADRA) K. Moore1, B.J. Rimel2, H. Achour3, G. Naumov4, S. Agarwal3, J. Balser5, B.J. Monk6 1University of Oklahoma Health Sciences Center, Gynecologic Oncology, Oklahoma City, USA 2Cedars-Sinai Medical Center, Gynecologic Oncology, West Hollywood, USA 3TESARO- Inc., Medical Affairs, Waltham, USA 4TESARO- Inc., Clinical Development, Waltham, USA 5Veristat- Inc., Biostatistics, Holliston, USA 6University of Arizona Cancer Center-Phoenix, Gynecologic Oncology, Phoenix, USA Background and Aims: Niraparib is an oral, once daily, PARP1/2 inhibitor currently in development for tumors with homologous recombination deficiency (HRD), including tumors with germline BRCA mutations (gBRCAmut). This phase 2, open-label, single arm study (QUADRA; NCT02354586) is evaluating the safety and efficacy of niraparib in ovarian cancer patients who have received at least three previous chemotherapy regimens (including prior PARP and/or angiogenesis inhibitors). Methods: All patients are administered 300 mg niraparib orally once daily in 28-day cycles. The primary objective is to evaluate the antitumor activity of niraparib by measuring the objective response rate (ORR). Secondary objectives are duration of response (DoR), disease control rate (DCR), progression-free survival (PFS), and safety and tolerability. Efficacy endpoints will also be evaluated in a prospective analysis in patients with tumors that have been identified as either BRCAmut and/or HRD+ (using the retrospectivelyidentified myChoice® HRD test). Exploratory objectives are pharmacokinetics, potential biomarkers of PARP inhibitor sensitivity and tolerability, and QTc interval in a subset of patients. Results: Interim primary efficacy results, safety data, and select secondary endpoints will be presented. Conclusions: We expect to see that niraparib is well-tolerated and provides antitumor activity.



784

IGCS-1004 OVARIAN CANCER SURGICAL COMPLEXITY, COMPLICATIONS AND SURVIVAL AFTER ADOPTING A STRATEGY OF PRIMARY AND COMPLETE CYTOREDUCTION IN OVARIAN CANCER: EXPERIENCE FROM A REFERRAL CENTER IN EASTERN INDIA A. Mukhopadhyay1, P. Lucksom1, D. Thangjam1, N. Siddiquee1, A. Ghosh1, B. Chakraborti1, J. Bhaumik1 1Tata Medical Center, Gynaecological Oncology, Kolkata, India Background and Aims: Between 2012 and 2014, interval surgery (IDS) with optimal cytoreduction was the preferred treatment modality for advanced epithelial ovarian cancers (AEOCS); we changed our strategy to increase primary cytoreduction (PDS) and CC0 resection rates since January 2015. Methods: Data was retrospectively collected up till 2014 and prospectively collected from hospital electronic records systems and Redcap database since 2015. Data was analysed for each 6 monthly intervals- P1 (JanJune 2012) to P8 (July-Dec 2015). Results: 94 patients underwent IDS between Jan 2012 and Dec 2014; 50 % recurred with 25% recurring within 6 months of completion of chemotherapy. PDS rate increased from 20% in P1 to 69% in P8. At 1 year follow up of patients operated in P7, 7% recurred in PDS group vs. 46% in IDS group. Mean SCS increased from 5.0 to 7.8 in IDS and 4.0 to 9.8 in PDS. Between Jan-Dec 2015, demographic characteristics between PDS (n=53/83, 64%) and IDS (n=30/83, 36%): PCI score ≥ 15 (72% vs 25%), SCS>8 (64.5% vs. 55.5% in AEOC), major comorbidities (62.7% vs 86.6%). 96% patients in both groups achieved CC0/CC1 cytoreduction. Grade 3/4 complications: Systemic (13.7% vs. 3.3%), Pulmonary (7.8% vs. 3.3%), Wound (17.6% vs 13.3%), GI/Hepatobiliary (7.8% vs 10%), 30 day mortality (1.8% vs. 3.3%). Overall major morbidity was not significantly different (33% vs 26%) between PDS and IDS; all complications showed downwards trend in P8 compared to P7. Conclusions: PDS should recommended as upfront therapy in a setting of quality assurance program to manage complications and increase survival in AEOCs.



785

IGCS-1194 OVARIAN CANCER FERTILITY SPARING SURGERY IN OVARIAN CANCER: EXPERIENCE FROM A TERTIARY REFERRAL CENTER IN EASTERN INDIA S. Mathai1, P. Lucksom1, B. Chakraborti1, A. Ghosh1, A. Mukhopadhyay1, J. Bhaumik1 1Tata Medical Center, Gynaecological Oncology, Kolkata, India Background and Aims: Malignancy in young women can cause significant psychological and social distress when fertility is affected as a result of disease or treatment of cancer especially in Indian socio-cultural background. Methods: Hospital electronic medical records were retrieved, up to date follow up status (April 2016) was recorded. Results: Between Jan 2012 and April 2016, fertility sparing surgery was done in 32 patients with ovarian pathology requiring staging or cytoreduction. Histology was as follows: Endometrioid carcinoma 3, clear cell 2, seromucinous 1, high grade serous 1, low grade serous 1, mucinous 2, serous borderline 6, mucinous borderline 2, immature teratoma 5, yolk sac 3, dysgerminoma 1 and granulosa cell tumour 1. Median age was 27 (range 10-41).15/32 women had FIGO stage 1A/1B disease, 9/32 had IC disease, 6/32 had stage 3 disease. In 27/32 women, uterus and one ovary was preserved, only uterus was preserved in 5 women. 16/32 women tried for pregnancy; pregnancy occurred in 4/16 (25%) women including 2 cases of IVF resulting in 2 live births, one missed miscarriage and one medical termination. 2/32 cases recurred; one 11 year old girl died of disease progression of yolk sac tumour, the other case of recurrence was seen in a case of immature teratoma. Conclusions: Fertility sparing surgery can be offered in appropriately selected patients with ovarian cancer. Counselling both by the oncologist and fertility specialist with knowledge of oncological aspects is required to optimize the clinical outcome and patients’ wishes.



786

IGCS-0566 OVARIAN CANCER NEOADJUVANT CHEMOTHERAPY IN ADVANCED OVARIAN CANCER: A SINGLE INSTITUTION EXPERIENCE AND A REVIEW OF THE LITERATURE V.V. Fumarulo1, V. Loizzi1, G. Cormio1, F. Murgia1, V. Del Vecchio1, V. Minicucci1, F.M. Crupano1, A. Camporeale1, L. Leone1, S. Grasso1, L. Resta2, E. Cicinelli1 12nd Unit of Obstetrics and Gynecology - University of Bari-, Department of Biomedical and Human Oncological Sciences DIMO, Bari, Italy 2University of Bari, Department of Pathology, Bari, Italy Background and Aims: The aim of this study was to evaluate the role of neoadjuvant chemotherapy (NACT) in advanced ovarian carcinoma patients unable to undergo a complete resection during primary debulking surgery (PDS). Methods: From February 2005 to October 2015, all consecutive cases of advanced stage epithelial ovarian carcinoma at the University of Bari were retrospectively recorded. Of them, patients treated with neoadjuvant chemotherapy were collected. Kaplan-Meier and Cox proportional hazards analyses were used to determine the predictors for survival. Results: Seventy-eight women with advanced stage epithelial ovarian carcinoma were treated with neoadjuvant chemotherapy. On univariate analysis, age (p=0.003), CA-125 serum level (0.001), response to NACT (p400,000/mm³ of platelet count before treatment, was analyzed in relation to clinical stage, histology and prognosis. Results: Paraneoplastic thrombocytosis was observed in 19.7% (59/300) of all study subjects. The detection rate of thrombocytosis significantly increased with FIGO stage: 10.4% in stage I (n=96), 13.9% in stage II (n=43), 23.3% in stage III (n=116) and 35.6% in stage IV (n=45) (p=0.003, c２ test for trend). Thrombocytosis was more common in serous adenocarcinoma (n=112) compared to the other histology (n=188) (26.8% vs. 15.4%, p=0.02), but the significance disappeared after adjustment for clinical stage (p=0.43). Overall, ovarian cancer patients with thrombocytosis were more likely to have a poor prognosis (5-year overall survival rate, 46.4% vs. 73.3%, p=0.0003). When the analysis was confined to women with stage III or worse disease, paraneoplastic thrombocytosis was still significantly associated with poor prognosis (5-year overall survival rate, 31.2% versus 53.2%, p=0.03). In a multivariate analysis including FIGO stage, histology and age, paraneoplastic thrombocytosis was an independent prognostic factor for overall and progression-free survival (p=0.005 and p=0.002, respectively). Conclusions: Our data suggested that paraneoplastic thrombocytosis may be an independent poor prognostic factor in epithelial ovarian cancer.



791

IGCS-1113 OVARIAN CANCER Hyperthermic intraperitoneal chemotherapy after secondary cytoreduction in epithelial ovarian cancer: A single-center experience M.M. Naki1, Y. Aykanat2, F. Alkhan1, F. Gokdaglı Sagır2, M.F. Kose1 1Medipol Mega University Hospital, Gynecologic Oncology, Istanbul, Turkey 2Medipol Mega University Hospital, Gynecology and Obstetrics, Istanbul, Turkey Background and Aims: Recently surgical cytoreduction followed by hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) introduced as treatment modality in advanced Epithelial Ovarian Cancer (aEOC). Objective of this study is to analyze postoperative complications and toxicity of CRS/HIPEC and outcomes of patients’ in recurrent aEOC.

Methods: In a retrospective study 12 patients that underwent CRS/HIPEC between June 2014-April 2016 were analysed. Toxicity of HIPEC, complications in postoperative thirty days and outcomes of patients were evaluated. All patients had CRS/HIPEC with closed abdominal technique. Maximal debulking surgery (none residual tumor) was achieved in 8 patients (66%), 4 patients had optimal debulking surgery (visible tumor ‹ 1 cm). Cisplatin 100 mg/m2/lt was used for HIPEC in patients with serous peritoneal carsinomatosis, mitomycin 25 mg/m2/lt was used in patients with mucinous carcinomatosis. Chemotherapeutic agents were given by intra-abdominal outflow with a temperature of 42 °C. The duration for HIPEC was 90 minutes for 9 patients and 45 minutes for the remaining 3. Results: Out of 12 patients 2 (16%) had mucinous carcinomatosis and remaining 10 had serous peritoneal carsinomatosis. Pleural effusion and atelectasis found in 4 patients (33%), 1 patient (8%) had bowel perforation, 1 (8%) had ileocutanous fistula and 2 patients (16%) had renal toxicity. In the follow up period (2 to 25 months), all of the patients were alive without recurrence of disease. Conclusions: CRS/HIPEC is a promising treatment for recurrent aEOC with an acceptable morbidity and mortality rate. Studies comparing complication rates of CRS and CRS/HIPEC and its impact on progression free and disease free survival is needed.



792

IGCS-0074 OVARIAN CANCER ASSOCIATION BETWEEN MENOPAUSAL ESTROGEN-ONLY THERAPY AND OVARIAN CANCER RISK A.W. Lee1, R. Ness2, L.D. Roman1, K.L. Terry3,4, C.L. Pearce5 1Keck School of Medicine- University of Southern California, Preventive Medicine and Obstetrics and Gynecology, Los Angeles, USA 2University of Texas School of Public Health, Houston, USA 3Brigham and Women's Hospital, The Obstetrics and Gynecology Epidemiology Center, Boston, USA 4Harvard Medical School, Obstetrics- Gynecology and Reproductive Biology, Boston, USA 5University of Michigan School of Public Health, Epidemiology, Ann Arbor, USA Background and Aims: Postmenopausal estrogen therapy (ET) use and duration of use in relation to risk of ovarian cancer, specifically within histological subtypes, remains controversial. Ten population-based case–control studies participating in the Ovarian Cancer Association Consortium were pooled to test this association. Methods: Self-reported data on ET use from each study were harmonized and conditional logistic regression was used. Adjustment variables considered in models included: Study, age, race–ethnicity, education, oral contraceptive use, tubal ligation, endometriosis, parity, body mass index, and age at menarche. Results: 906 women with ovarian cancer and 1,220 controls, all having had a hysterectomy, were included. 43.5% of women in the control group reported previous use of ET. Compared with them, current or recent ET use was associated with a significant increased risk for serous (Odds Ratio [OR] 1.63, 95% confidence interval [CI] 1.27–2.09) and endometrioid (OR 2.00, 95% CI 1.17–3.41) subtypes. Statistically significant trends demonstrated greater risk with longer duration of current or recent use for both serous and endometrioid types (Ptrend,.001). Long duration of use (10 years or more) drove much of the association among current or recent users. Ten+ years of use substantially elevated the risk for serous (OR 1.73, 95% CI 1.26–2.38) and endometrioid (OR 4.03, 95% CI 1.91–8.49) ovarian cancers as compared to controls. Conclusions: We found an increased risk of serous and endometrioid ovarian cancers associated with postmenopausal ET use, particularly of long duration. These findings emphasize the risk associated with extended ET use.



793

IGCS-0070 OVARIAN CANCER A COMPARISON OF HE4 WITH CA125, RISK OF OVARIAN MALIGNANCY ALGORITHM (ROMA) AND COPENHAGEN INDEX (CPH-I) IN CLASSIFICATION OF OVARIAN ENDOMETRIOSIS IN PREMENOPAUSAL WOMEN T. Nikolova1, R. Zivadinovic2, N. Evtimovska3, V. Klisarovska4, J. Georgievska1, N. Nikolova5 1University Clinic of Obstetrics and Gynecology, Gynecology, Skopje, FYR Macedonia 2University Clinic of Obstetrics and Gynecology- Clinical Center, Gynecological Oncology, Nis, Serbia 3University Clinic of Oncology and Radiotherapy, Biochemical laboratory, Skopje, FYR Macedonia 4University Institute of Oncology and Radiotherapy, Gynecological Oncology, Skopje, FYR Macedonia 5University Clinic of Obstetrics and Gynecology, Resident in Ob/Gyn, Skopje, FYR Macedonia Background and Aims: To compare the Human epididymis protein 4 (HE4) with Cancer antigen 125 (CA125), Risk of ovarian malignancy algorithm (ROMA) and Copenhagen Index (CPH-I) in classification of ovarian endometriosis in premenopausal women. Methods: Prospective, observational, comparative study performed at the University Clinic of Obstetrics and Gynecology in Skopje included 37 premenopausal women with advanced ovarian endometriosis (ASRM stage III and IV), 11 patients with ovarian carcinoma primary diagnosed by ultrasound and 57 healthy controls. Cases underwent surgical intervention with the material histologically verified. Histological diagnosis was related to the results of all upper mentioned parameters. Sensitivity, specificity, positive and negative predictive values and accuracy for HE4, CA125, ROMA and CPH-I were calculated. Results: For the cut-off of 70pmol/L, HE4 showed the following efficiency: SEN 81,82%; SPC 100%; PPV 100%; NPV 94,87%; ACC 95,83%. CA125 with cut-off of 35 U/ml: SEN 81,82%, SPC 48,65%; PPV 32,14; NPV 90,00%; ACC 56,25%. ROMA with cut-off 7,4: SEN 90,91%; SPC 83,78%; PPV 62,50%; NPV 96,88%; ACC 85,42%. CPH-I with cut-off 0,70: SEN 81,82%; SPC 97,30%; PPV 90,00%; NPV 94,74%; ACC 93,75%. Conclusions: Conclusion: HE4 performed the best in separation endometriosis from ovarian cancers (SPC = 100%, ACC = 95.83%), while CPH-I performed well in that separation, predicting only one false positive patient (SPC = 97.30%, ACC = 93.75%). CA 125 performed worst (SPC 48,65%; ACC 56,25%). Confirming that HE4 and CPH-I are both precise in discrimination of endometriosis from ovarian cancers in premenopausal women.



794

IGCS-0071 OVARIAN CANCER COMPARISON OF HE4 WITH CA125, RISK OF MALIGNANCY INDEX AND MORFOLOGY INDEX IN DISCRIMINATION OF ENDOMETRIOSIS IN PREMENOPAUSAL WOMEN T. Nikolova1, R. Zivadinovic2, N. Evtimovska3, J. Georgievska1, N. Nikolova4 1University Clinic of Obstetrics and Gynecology, Gynecology, Skopje, FYR Macedonia 2University Clinic of Obstetrics and Gynecology- Clinical Center, Gynecological Oncology, Nis, Serbia 3University Clinic of Oncology and Radiotherapy, Biochemical Laboratory, Skopje, Serbia 4University Clinic of Obstetrics and Gynecology, Resident in Ob/Gyn, Skopje, FYR Macedonia Background and Aims: To compare Human epididymis protein 4 (HE4) with Cancer antigen 125 (CA125), Risk of ovarian malignancy index and Morfology index in discrimination of ovarian endometriosis from epithelial ovarian carcinoma (EOC) in premenopausal women. Methods: Prospective, comparative study performed at the University Clinic of Obstetrics and Gynecology in Skopje included 37 premenopausal women with advanced ovarian endometriosis (ASRM stage III and IV),11 with EOC, primary diagnosed by ultrasound and 57 healthy controls. Cases underwent surgical intervention and the material got histologically verified. Histological diagnosis was related to the results of all upper mentioned parameters. Sensitivity, Specificity, Positive (PPV) and Negative Predictive Value (NPV) and Accuracy (ACC) for HE4, CA125, RMI and MI were calculated. Results: For the cut-off of 70pmol/L, HE4 showed the following validity: SEN 81,82%; SPC 100%; PPV 100%; NPV 94,87%; ACC 95,83%. CA125 with cut-off of 35 U/ml: SEN 81,82%, SPC 48,65%; PPV 32,14; NPV 90,00%; ACC 56,25%. RMI with cut-off 25: SEN 90,91%; SPC 35,14%; PPV 29,41%; NPV 92,86%; ACC 47,92%. MI with cut off of 5: SEN 100,00%; SPC 75,68; PPV 55,00%; NPV 100,00%; ACC 81,25%. Conclusions: HE4 performed best, separating ovarian endometriosis from EOC while RMI performed worst, predicating many false positive results. Confirming that HE4 is the most powerful discriminating ovarian endometriosis in premenopausal women.



795

IGCS-0764 OVARIAN CANCER A NOVEL DIGITIAL PATHOLOGY APPROACH TO DEFINITIVELY IDENTIFY OVARIAN CANCER CTCS C. Spillane1,2,3, B. Ffrench4, A. Cooney1,2, C. Ruttle3,5, A. Bogdanska5, N. Gleeson6, F. Abu Saadeh6, K. Waseem6, C. O'Riain7, R. Flavin7, M. Gallagher1,2, C. Martin1,2, O. Sheils1,3, S. O'Toole1,5, J. O'Leary1,2,3 1Trinity College Dublin, Department of Histopathology, Dublin, Ireland 2The Coombe Women & Infants University Hospital, Pathology Research Department, Dublin, Ireland 3Dublin City University, The Biomedical Diagnostics Institute, Dublin, Ireland 4Royal College of Surgeons in Ireland, Department of Surgery, Dublin, Ireland 5Trinity College Dublin, Department of Obstetrics and Gynaecology, Dublin, Ireland 6St. James’s Hospital, Departments of Gynaecological Oncology, Duiblin, Ireland 7St. James’s Hospital, Departments of Histopathology, Duiblin, Ireland Background and Aims: Historically ovarian cancer was not considered to hematogenously metastasise. However, Pradeep et al., (2014) demonstrated, using mouse models, metastatic dissemination through the circulation by ovarian cancer cells. This is significant, as circulating tumour cells (CTCs) are seen as a valuable new tool to detect and monitor cancer. As with any early technologies, there are technical issues; including the dependency of CTC identification on epithelial markers, which are often lost during metastasis. This study aimed to overcome current marker based limitations and to evaluate CTCs in ovarian cancer patients. Methods: CTCs were isolated from whole blood using ScreenCell®Cyto filtration devices. Filters were slide mounted, giemsa stained and digitised. Filters were washed, immunofluorescently stained for EpCAM/panCK, CD45, HER3 and DAPI and digitally imaged. Giemsa and 4-colour immunofluorescent digital images were processed in silico, generating a single z-stacked digital image for pathological review. Results: This study developed a novel staining pipeline (CTC-5) combining histochemical (giemsa) and immunofluorescent staining, with whole slide imaging for robust identification, enumeration and characterisation of CTCs. CTC-5 was validated using peripheral blood from healthy donors and spiked-in controls. Furthermore, in a cohort of ovarian cancer patients both epithelial (EpCAM/panCK) and HER3 positive CTCs were detected. Conclusions: CTC-5 overcomes recognised weaknesses in CTC characterisation. Histochemical staining is combined with EpCAM/panCK and CD45 staining (current gold standard), with a further channel for assessment of biomarker status (e.g. HER3). This enables robust pathological assessment of CTCs in the clinic, which has allowed us to definitively demonstrate the presence of CTCs in ovarian cancer patient samples.



796

IGCS-0458 OVARIAN CANCER Prognostic factors in suboptimal residual stage III/IV epithelial ovarian carcinoma A. Ogasawara1, K. Hasegawa1, D. Shintani1, S. Sato1, Y. Yano1, M. Miwa1, A. Miyasaka1, A. Yabuno1, A. Kurosaki1, H. Yoshida1, K. Fujiwara1 1International Medical Center - Saitama Medical University, Gynecologic oncology, Hidaka, Japan Background and Aims: No residual disease at primary or interval debulking surgery (IDS) has been reported as an independent variable in predicting overall survival in ovarian cancer. However, prognostic factors in patients who have suboptimal disease at primary surgery have not been well studied. The aim of this study is to explore prognostic factors in patients with advanced ovarian cancer after suboptimal surgery. Methods: We retrospectively analyzed for prognostic significance of the various clinicopathological factors in 151 patients with stage III/IV ovarian, fallopian tube and primary peritoneal carcinoma, who had suboptimal disease at primary surgery in our center between April 2007 and March 2015. Results: A total of 151 patients were analyzed, and median follow-up was 29 months. 94 (62.3%) patients has received IDS. Median progression free survival (PFS) and overall survival (OS) were 18 and 44 months, respectively. Univariate analysis showed that the number of chemotherapy cycles, objective response, histology and IDS were significant predictors for both PFS and OS. All these factors remain significant predictors for both PFS and OS in multivariate analyses. Conclusions: Number of chemotherapy cycles, objective response, histology and IDS were significant prognostic factors for both PFS and OS in patients with ovarian carcinoma who had suboptimal residual disease at primary surgery.



797

IGCS-0618 OVARIAN CANCER Four pathological subtypes of high-grade serous carcinoma of ovary, fallopian tube and peritoneum show distinct clinical features T. Ohsuga1, K. Yamaguchi1, R. Murakami1, K. Abiko1, J. Hamanishi1, T. Baba1, N. Matsumura1, I. Konishi1 1Kyoto university hospital, gynecology and obstetrics, Kyoto, Japan Background and Aims: The Cancer Genome Atlas Research Network reported that high-grade serous carcinoma (HGSC) is classified into four subtypes based on gene expression profiles and termed them ‘‘mesenchymal,’’ ‘‘immunoreactive,’’ ‘‘proliferative,’’ and ‘‘differentiated.’’ Previously we established a novel pathological classification of HGSC correlated with the gene expression subtypes; Mesenchymal Transition (MT), Immune Reactive (IR), Solid and Proliferative (SP), and Papillo-Glandular (PG). MT shows scattered invasion with a remarkable desmoplastic reaction. IR has numerous lymphocyte infiltrations. SP is characterized by a solid growth pattern. PG has a papillary architecture. Methods: The purpose of this study is identification of distinct clinical findings among the four pathological subtypes of HGSC and prediction of pathological subtype by preoperative images. We assessed 65 HGSC cases (IR: 18, MT: 27, SP: 17, PG: 7) and analyzed clinical parameters and preoperative images retrospectively. Results: All IR were ovary or fallopian tube origin (p=0.0268). IR showed significantly earlier stages and possessed less peritoneal dissemination, omental cake, ascites and distant metastasis compared with the other subtypes (p3cm) had statistically significant difference as compared to patients with tumors size (≤3cm) in disease-free survival. Five patients were recovered, but one patient died of recurrence. Conclusions: Tumor diameter (>3cm) was a recurrent risk factor in the present study. Patients with tumor diameter(>3cm) might require careful observation even a low-risk group of recurrence. Moreover patients with symptoms at the time of recurrence, was only 1 person.Even for the low-risk group of patients, it may be necessary to the periodic medical examination carefully, particularly within two years.



1017

IGCS-0914 UTERINE CANCER INCLUDING SARCOMA LYMPH NODE INVASION AND THERAPEUTIC ROLE OF LYMPHADENECTOMY IN ENDOMETRIOID ENDOMETRIAL CANCER: RETROSPECTIVE STUDY IF PROSPECTIVELY COLLECTED DATA S. Petousis1, I. Kalogiannidis1, C. Margioula-siarkou1, G. Mavromatidis1, A. Mamopoulos1, N. Prapas1, D. Rousso1 1Aristotle University of Thessaloniki, 3rd Deparment of Obstetrics and Gynaecology, THESSALONIKI, Greece Background and Aims: Το define the rate of lymph node invasion and the therapeutic value of pelvic and/or paraortic lymphadenectomy in patients with high-risk endometrioid (type I) endometrial cancer. Methods: A retrospective study of prospectively collected data was performed regarding the period 1996-2011. Cases with endometrioid endometrial cancer were included, while patients with coexisting malignancy and incomplete follow-up were excluded. High-risk cases were studied in terms of lymphadenectomy performance, number of resected and invaded total, pelvic and paraortic nodes. Primary outcomes were the lymph mode invasion rate and the number of invaded lymph nodes. Secondary outcome was to define the therapeutic value of lymphadenectomy and number of resected nodes as well as the prognostic value of invaded lymph nodes in overall survival (OS), cancer-related survival (CRS) and disease-free survival (DFS). Results: There were 171 cases meeting inclusion criteria. Mean age was 62.7 years. The median follow-up was 67 months (9-124 months). Pelvic lymphadenectomy was performed in 53 cases, while paraortic in 7 of them. Lymph node invasion was observed in 13.2% of cases (n=7). Mean number of resected lymph nodes was 10.6 ± 5.6 (range 2-22), while invaded lymph nodes ranged from 0-10. Pelvic lymphadenectomy was not significantly correlated with survival outcomes, while paraortic lymphadenectomy was independently associated with increased OS (P=.02), DFS (P=.006) and CRS (P=.006). Pelvic node invasion and number of invaded nodes were univariately but not independently correlated with survival outcomes. Conclusions: The present study indicates a potential therapeutic role of paraortic lymphadenectomy that needs to be further assessed in larger number size.



1018

IGCS-0474 UTERINE CANCER INCLUDING SARCOMA Comparison between laparotomy and laparoscopic surgery for the treatment of early stage endometrial cancer K. Katayama1, G. Hirata1, Y. Ishidera1, Y. Oi1, H. Shigeta1, H. Yoshida1 1Yokohama Municipal Citizen's Hospital, obstetrics and gynecology, Yokohama, Japan Background and Aims: Recently laparoscopic approach tends to be chosen for the treatment of early stage endometrial cancer as a minimally invasive surgery. We compared 41 cases who underwent laparotomy and 47 cases who underwent laparoscopic surgery for early stage endometrial cancer in 2 hospitals in Yokohama, Japan. Methods: Total hysterectomy or modified radical hysterectomy was performed and additional pelvic lymphadenectomy was employed according to the condition of the disease.We compared laparotomy and laparoscopic surgery. Results: When we compared laparotomy and laparoscopic surgery, the median operative time was 166 min (75~386) and 165 min (83~316) (P=0.25), the median blood loss was 410 ml (60~2300) and 140 ml (a small quantity ~ 800) (P1 positive Ln (14.8+7 vs. 20.7+11.9; p=0.03). Adjuvant therapy was comparable between groups. Patients with >1 positive LN had a higher recurrence rate (76% vs. 45%, p=0.04) and a shorter disease-free survival (p=0.06); recurrences in the >1 positive Ln group were more frequently locoregional (p=0.07). Overall survival was similar between groups (p=0.97).

Conclusions: Women with > 1 positive Ln seem to have a higher tendency to recur and a shorter disease-free survival, but may be more prone to be salvaged due to the specific location of their relapses.



1078

IGCS-1135 UTERINE CANCER INCLUDING SARCOMA THE PARAMETRIAL AND PELVIC LYMPH NODES INVOLVEMENT IN SURGICAL-PATHOLOGIC STAGE II ENDOMETRIAL CARCINOMA R. Puente1, E. Schneider1, R. Miranda1 1Universidad Austral de Chile, Institute of Obstetrics and Gynecology, Valdivia, Chile Background and Aims: To know if the invasion of cervical stroma by endometrial cancer is associated to an increased percentage of parametrial and pelvic lymph nodes involvement in patients surgically staged II (FIGO 2008).

Methods: In 150 patients with endometrial carcinoma, all with endometrioid histology submitted to radical hysterectomy type A or B with bilateral salpingoophorectomy and systematic pelvic lymphadenectomy we had 22 patients (14.6%) with pathologic study in strict stage II. The pathologic study included the pelvic lymph nodes and parametrial status Results: In the group of 22 patients stage II endometrioid adenocarcinomas we had an average of 35 pelvic lymph nodes (range 11-41), with 2 patients with positive pelvic lymph nodes (9.0%). No patient had positive parametrial involvement at pathologic study. Conclusions: According to this study, in surgical-pathologic endometrial endometrioid adenocarcinoma stage II, the risk of positive pelvic lymph nodes is 9% without involvement of parametria.



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IGCS-0979 UTERINE CANCER INCLUDING SARCOMA Endometrial Carcinosarcoma, a retrospective study of 5 year F. Rafael1, A.P. Soares1, R. Mata1, S. Costa1, P. Guedes1, V. Flor1, F. Guerrreiro1 1Centro Hospitalar do Algarve - Unidade de Portimão, Serviço de Ginecologia e Obstetricia, Portimão, Portugal Background and Aims: A 5 years study of all the cases of endometrial carcinosarcoma diagnosed and treated at Centro Hospitalar do Algarve, Portimão’s Unit. Methods: We collected information of all cases of endometrial carcinosarcoma, based on medical records. We evaluated risk factors, HPV type, stage and treatment of all cases, as well as the survival rate. We analised the data with SPSS Software.

Results: Most cases were diagnosed in stage Ib. Almost all patients underwent total hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy. A minority underwent radiotherapy and chemotherapy. The survival rate at 5 years was reduced, especially in advanced stages. Conclusions: Endometrial Carcinosarcoma is an uncommon cancer with a bad prognosis. The main factors for improved survival rate were early diagnosis and timely treatment.



1080

IGCS-1064 UTERINE CANCER INCLUDING SARCOMA Prospective analysis of Indocyanine Green (ICG) Sentinel Lymph Node Mapping in Robotic Surgery L. Mereu1, E. Terreno1, R. Carlin1, A. Ricci1, F. Corbisiero1, E. Perin1, S. Tateo1 1Ospedale Santa Chiara, UO ginecologia e ostetricia, Trento, Italy Background and Aims: Sentinel lymph node (SLN) mapping with ICG is the new frontier for surgical staging of apparently early stage cervical (CC) and endometrial cancer (EC). To evaluate the accuracy of robotic SLN biopsy guided by cervical ICG, in patients with EC and CC. Methods: This prospective analysis included 28 not consecutive patients with EC or CC undergoing ICG SLN mapping at our Hospital from January 2014 to May 2016. SLNs were located using the robotic camera (Firefly System®) and excised. Following surgery consisted in systematic pelvic (PLND) ± paraortic lymphadenectomy (PALND) associated with radical hysterectomy (type A and B) and bilateral salpingooophorectomy. Results: We collected 22 patients with EC and 6 with CC: 9 underwent only SLN biopsy, 15 SLN mapping followed by PLND and 3 SLN mapping followed by PLND and PALND. Overall detection rate was 85.7% (70.8% bilateral and 29.2 % unilateral); in 4 of the first 9 cases we didn’t find any SLNs. Detection rate after the first 10 cases was 100%. In 2 patients we found SLN metastasis: one micrometastasis and one lymph nodes with isolated tumor cells. The median number of removed SLNs, pelvic and para-aortic LNs was 2 (range 0-6), 19 (range 10-33) and 16 (range14-19), respectively. We didn't find metastasis in PLN and PALN. The mean operative time was 222.17 minutes.

Conclusions: Robotic ICG SLN mapping has excellent overall and bilateral detection rates and a low FN rate, especially after the surgeon's learning curve that can be estimated in 10 cases.



1081

IGCS-1177 UTERINE CANCER INCLUDING SARCOMA UTERINE ENDOMETRIAL CARCINOMA: 7 YEARS OF EXPERIENCE WITH LONG-TERM FOLLOWUP AT A SINGLE CHILEAN INSTITUTION O. Puga1, M.V. Perez1, E. Orlandini2, N. Saez1, M. Urzua2, M. Farias2 1Hospital Dr Sotero del Rio, Gynecology Oncology, Santiago, Chile 2Pontificia Universidad Católica de Chile, Gynecology Oncology, Santiago, Chile Background and Aims: Endometrial cancer incidence is increasing in our country and there are some controversies in the management of this patients. Our objective was to evaluate demographic, clinopathologic characteristics, surgery staging and long follow up for patients with endometrial cancer Methods: Retrospective review of patients with endometrial cancer treated between 2005 and 2011 at the department of Obstetric and Gynecology of Hospital Dr Sótero del Rio, Santiago de Chile Results: We analyzed 131 patients, median age was 60 years (range 27-85). 22 were nulliparous. Surgical staging depends of frozen section. Histology were adenocarcinoma in 105 (83%), serous 8 (6%), clear cell 7 (5%), undifferenciated carcinoma 2(1.5%), others 5 (4%). Frozen section results were agreement with permanent section in 57% for histological grade (kappa 0.25, p=0,0015), 66% for depth of myometrial invasion (kappa 0,4. p=0,0001). Stage IA 60 patients (46%), IB 25(19%), II 8(6%), III 20(15%) and 15(11%) stage IV, complementary therapy was chemotherapy in 27 patients,18 radiotherapy and both in 5. Five years overall survival was 57 %, median global survival was 63,4 ± 2,9 month (mean ±SEM), range 1 – 125 month. Survival by stage; IA 86%, IB 84%, II 31, III 39%, IV none. By histologic grade were 70%, 59% and 53% for G1, G2 y G3 respectivally. By myometrial depth invasion, 50% = 46% Conclusions: Frozen section is determinant for intraoperative decision and myometrial depth invasion is the most important factor. The survival rates are lower than international data, maybe because the diagnoses for recurrence and complementary therapy are late



1082

IGCS-0598 UTERINE CANCER INCLUDING SARCOMA UTERINE SARCOMA: 13 YEARS IN A SINGLE INSTITUTION C. Santos1, G. Atalaia1, A. Faria1, F. Gomes1, T. Fiúza1 1Hospital Prof. Dr. Fernando Fonseca, Oncology, Amadora, Portugal Background and Aims: Uterine sarcomas are rare, aggressive, have a poor prognosis and account for less than 10 percent of all uterine malignant neoplasms. The aim of this retrospective analysis is to report the clinical outcome of patients with uterine sarcoma treated at a single center. Methods: The data was obtained regarding the patient's characteristics, clinical presentation, pathological results, treatments and survival of all uterine sarcoma patients diagnosed in a single center between 2003 and 2015. Results: A total of 40 case records were retrieved and the mean age was 62 years. In total 33 patients were postmenopausal and 2 patients reported use of tamoxifen over 5 years. The major initial symptoms were uterine bleeding and pelvic pain. On pathology analysis, endometrial stromal sarcomas accounted for 20 % (6 low-grade and 2 undifferentiated), Leiomyosarcomas 32,5%, Carcinosarcomas 45% and Adenosarcoma 2,5%. International Federation of Gynecology and Obstetrics stage distribution was stage I: 24; stage II: 7; stage III: 4; stage IV: 5. All patients underwent surgery and 42,5% received adjuvant treatment. Patients with progressive disease (mainly pulmonary metastasis) were treated with palliative chemotherapy or best supportive care. Median follow-up period was 52 months (range 2-157 months). The OS at 5 years was 37,9%. At the date of the analysis 24 patients were still on follow-up.Conclusions: Primary surgery is recommended for uterine sarcoma and adjuvant treatment decreases local and systemic recurrences. Uterine sarcomas differ clinically between each other and as such, treatment regimens should be tailored to each type of histology.



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IGCS-1237 UTERINE CANCER INCLUDING SARCOMA 3D-US for predicting the invasion endometrial cancer D.K. Saputra1, M. Schmidt2 1SRH Zentral Klinikum Suhl, Department of Gynecology, Suhl, Germany 2, Suhl, Germany Background and Aims: Three-dimensional (3D) ultrasound offers several options extending conventional two-dimensional scanning. Three perpendicular planes displayed simultaneously can be rotated by the sonographer and translated in order to obtain accurate sections and suitable views 1. Endometrial carcinoma is the fourth most frequent type of cancer among women in Germany, with more than 11000 newly cases each year 2. The aim of this paper is to address the invasion prediction endometrial cancer with 3D-US. Methods: A 77-year-old woman was referred to our hospital because of postmenopousal bleeding,myoma history,menopouse with 53 years old,on medication Rivaroxaban 20 mg after a previous three times pulmonary embolism,and many comorbidities,e.g.severe tricuspidal heart valve insufficiency,severe chronic obstructive pulmonary disease,and essential arterial hypertension.The Typ I endometrial carcinoma Grad.2 was diagnosed based on histopathological findings. Results: B-Mode shows the suspected irregularity endometrial hyperechoic area,with intramural myomas. 3D delivers the prediction“ > 50% myometrial invasion“.After informed concent she was not in agreement for any lymphadenectomy. The abdominal hysterectomy with bilateral adenexectomy,and abdominal fluid cytology(carcinoma cells free)was done successfully. The histopathology confirms our invasion prediction pT1b,pNx,L0,V0,Pn0,R0 (FIGO IB) with leiomyomas. Conclusions: 3D ultrasound is increasingly used into clinical practice especially in gynaecology oncology .Computed tomography and magnetic resonance imaging are not essential as staging if sonography performed by a specialist3,4.3D-US is an accurate method to assess the depth of invasion in women with endometrial cancer.



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IGCS-1175 UTERINE CANCER INCLUDING SARCOMA Prognostic factors and treatment outcomes of uterine carcinosarcoma W. Sbika1, Y. Yahyaoui2, C. Bousrih2, L. Naija3, A. Mokrani4, L. Mchella5, A. Mezlini6 1, Hammam Lif, Tunisia 2Salah Azaiez Institute, departement of medical oncology, Tunis, Tunisia 3Salah Azaiez Institute, departement of surgical oncology, Tunis, Tunisia 4Salah Azaiez institut, departemement of medical oncology, Tunis, Tunisia 5Salah Azaiez institut, departement of surgical oncology, Tunis, Tunisia 6Salah Azaiz institute, departmement of medical oncology, Tunis, Tunisia Background and Aims: Uterine Carcinosarcoma (UCS), also called malignant mixed Mullerian tumor (MMMT), is rare (less than 5% of all uterine malignancies) but very agressive. The aims of this study were to determine the prognostic factors, survival outcomes and response to adjuvant therapy in women with UCS. Methods: We report 44 cases of UCS treated at Salah Azaiez Anti-cancer Institute from 1998 to 2013. The different treatment modalities were analyzed to determine prognostic factors for overall survival (OS). Results: The median age was 62 years and 86, 3% of women were menopausal. The most common presentation was abnormal vaginal bleeding (65, 9%). The majority of patients (61, 3%) had an advanced disease (stage III or IV). Eighty-eight percent of patients underwent surgery (hysterectomy and bilateral salpingooophorectomy). Only 47, 7% of patients had pelvic node dissection. Pathological review showed that there was 68, 3 % of heterologous elements in the sarcomatous component of the tumours. Pelvic node metastasis was detected in 12 out of the 44 women. Fourty five percent of women had adjuvant therapy after surgery (8 patients underwent chemotherapy versus 12 radiotherapy). After a median follow up of 27, 1 months, the 2-year OS was 59, 2%. The significant prognostic factors were stage (p=0,023), heterologous subtype (0,032) and postoperative radiotherapy (p=0,045). Conclusions: The poor overall survival for UCS suggests the need for improved management strategies. More studies are needed to better define the appropriate treatment for this rare cancer. Future research should focus on targeted therapies.



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IGCS-0275 UTERINE CANCER INCLUDING SARCOMA TREATMENT OUTCOMES OF PATIENTS WITH UTERINE CANCER TREATED WITH LAPAROTOMY COMPARED TO ROBOTICALLY ASSISTED LAPAROSCOPIC APPROACH K. Seader1, E. Hashemi1, G. Sommers1, P. Anderson1 1Newark Beth Israel Medical Center, Obstetrics and Gynecology, Newark, USA Background and Aims: To evaluate and compare the treatment outcomes of patients with endometrial cancer treated by laparotomy compared to robotically assisted laparoscopic approach. Methods: A retrospective chart review of endometrial cancer patients treated surgically from January 2003 - March 2016. Age, body mass index (BMI), FIGO staging, final pathology, blood loss, intra-operative and postoperative complications, mean hospital length of stay, lymph node yield, duration of follow up, reoccurrence, need for adjuvant radiation/chemotherapy were compared. Results: A total of 225 cases were reviewed: 138 cases of abdominal hysterectomy and 87 cases of robotic assisted hysterectomy. The groups were demographically similar. Over 50% of patients in each group had no prior abdominal surgery. The majority of patients had endometrioid type endometrial carcinoma. Table 1: Distribution by stage.

Table 2: Surgical outcomes.



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The median follow up was 23 months in the laparotomy group and 35 months in the laparoscopic group (P=NS). Table 3: Disease outcome.

Conclusions: This study provides evidence that robotic laparoscopic surgery is adequate and a feasible treatment of endometrial cancer with comparable surgical and oncological outcomes. The robotic group proved to have significantly less blood loss and hospital length of stay. Finally, the complication rates are greater in the laparotomy group. The recurrence rate appears to be greater in the robotic group.



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IGCS-0903 UTERINE CANCER INCLUDING SARCOMA LVSI IS THE MOST IMPORTANT PREDICTOR OF LYMPH NODE METASTASIS IN TYPE 2 ENDOMETRIAL CANCERS I. Selcuk1, M. Oz1, E. Sari1, N. Cetinkaya1, H. Bayramoglu2, M.M. Meydanli1, T. Gungor3 1Zekai Tahir Burak Woman's Health Education and Research Hospital, Gynecologic Oncology, Ankara, Turkey 2Zekai Tahir Burak Woman's Health Education and Research Hospital, Pathology, Ankara, Turkey 3Hitit University Department of Obstetrics and Gynecology / Zekai Tahir Burak Woman's Health Education and Research Hospital, Gynecologic Oncology, Ankara, Turkey Background and Aims: To determine the predictors of lymph node metastasis in type 2 endometrial cancers. Methods: A total of 75 women with type 2 endometrial cancer who were operated between January 2009 and January 2016 at the Department of Gynecological Oncology, Zekai Tahir Burak Women’s Health Education and Research Hospital were analyzed retrospectively. Results: Serous hystology was detected in 43 (57.3%) women and 32 (42.7%) patients were with clear cell carcinoma. Median age of the patients was 64. Mean tumor diameter and mean number of dissected lymph nodes were 3.7±2.5 and 63.9±23 respectively. Lymph node metastasis was detected in 28 (37.3%) of patients. In univariate analysis positive peritoneal cytology (p=0.041), adnexeal involvement (p=0.016), lympho-vascular space involvement (p=0.001) and uterine serosal tumor positivity (p=0.013) were detected as significant predictors of lymph node metastasis. However, in multivariate analysis only lympho-vascular space involvement was detected as significant predictor of lymph node metastasis (p=0.024).

Conclusions: For type 2 endometrial tumors, lympho-vascular space involvement is the most significant predictor of lymph node involvement.



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IGCS-0913 UTERINE CANCER INCLUDING SARCOMA OBESITY IS NOT A RATE-LIMITTING STEP FOR LYMPHADENECTOMY DURING OPEN PROCEDURES I. Selcuk1, E. Ozgu1, M. Oz1, Z. Firat Cuylan1, A. Oskovi1, E. Sari1, N. Topfedaisi Ozkan1, M.M. Meydanli1, T. Gungor2 1Zekai Tahir Burak Woman's Health Education and Research Hospital, Gynecologic Oncology, Ankara, Turkey 2Hitit University Department of Obstetrics and Gynecology/ Zekai Tahir Burak Woman's Health Education and Research Hospital, Gynecologic Oncology, Ankara, Turkey Background and Aims: To determine the role of obesity on the dissected lymph node counts during endometrial cancer surgery. Methods: Two hundred endometrium cancer patients who had surgical staging between January 2012 and January 2016 at Zekai Tahir Burak Woman’s Health Education and Research Hospital were analyzed retrospectively in regard to the obesity classification for dissected lymph node counts. Operations were performed by four senior gynecological oncologists and no automatic retractors has been used during the operations. Results: Median age of the patients was 58 and median body mass index (BMI) was 31.8 kg/m2 (ranging 20.1-51.2 kg/m2). The number of mean dissected lymph nodes for pelvic and paraaortic regions were 40.2±16 and 18.1±9.6 respectively. Endometrioid, serous and clear cell histology was detected in 79.1%, 6% and 5.5% of cases, respectively. 78 (39%) patients were not obese (