288 SOCIETY OF GYNECOLOGIC ONCOLOGISTS-ABSTRACTS

patients died of therapy-related complications. Following treatment, patients were seen regularly from 1.8 to 18.4 years (mean 5.4 years) and none were lost to follow-up. The estimated 5- and IO-year disease- free survival rates were 88 and 76%, respectively. Cell type, depth of myometrial penetration by tumor, and lymph node status were of prog- nostic significance (P < 0.01). Age, uterine size, and presence of gross cervical involvement were not of prognostic importance. These data confirm that preoperative RT followed by extrafascial hysterectomy with para-aortic node dissection is an effective treatment method in patients with Stage II endometrial cancer. The relevance of these find- ings to the new FIG0 staging system is discussed.

14. Methotrexate and Low-Medium Risk Gestational Trophoblastic Neoplasia. ROBERT D. HILGERS, EDWARD S. NEWLANDS, HUGH

MITCHELL, RICHARD HOFFMAN, AND KENNETH D. BAGSHAWE, South- em Illinois University, Springfield, Illinois, and Charing Cross Hospital, London, England, United Kingdom.

Serum methotrexate (MTX) levels were measured in 18 patients with low-medium risk gestational trophoblastic neoplasia to determine (1) hCG response and (2) response to therapy. Treatment consisted of 50 mg MTX im on Days 1, 3, 5, and 7 followed by 6 mg Citrovorum Factor (CF) im 30 hr later on Days 2, 4, 6, and 8. Serum MTX con- centration peaked over a I-hr period (5-6 x 10m6 M/liter) beginning 15 min after administration. Rapid plasma disappearance occurred over the next 24 hr (=lOO-fold fan) to levels of 3-5 x lo-* M/liter at 48 hr. No cumulative effect was observed. Twelve patients underwent remission, three had drug resistance, two relapsed, and one, a pla- cental-site trophoblastic tumor, manifested drug resistance from the onset. No difference was observed in the plasma pharmacokinetics of MTX or in serum PhCG levels between the responder (N = 12) and drug resistance/relapse group (N = 5). Similarly the administered dose was not statistically different in the two groups. Serum MTX levels, resulting from a dose of -30 mg/m’ on alternate days with CF, de- livered to the neoplastic trophoblastic cell, do not appear responsible for drug resistance or relapse. Drug failure appears to occur at the cellular level.

15. Modern Approach to Triage of Atypical Cervical Cytology. M. J. CAMPION, S. L. Hosroao, E. W. FRANKLIN III, M. A. CROZIER,

F. M. DI PAOLO, R. ROTHROCK, AND F. VELLIOS, Cancer Treatment and Research Center, Saint Joseph’s Hospital, Atlanta, Georgia 30342.

The increased frequency of atypical cervical smear reporting and the risk of significant cervical neoplasia in these patients demand critical review of current approaches to triage. A study group of 443 consec- utive women presenting to a colposcopy clinic with a history of an atypical (Class II) smear were recruited for study. Each patient was triaged using repeat cervical cytology, DNA hybridization for specific human papillomavirus types using the Virapap/Viratype technology, and cervicography. Each patient was colposcoped and directed biopsies were taken from areas of cervical atypia. Patients with atypia on any screening test but negative colposcopic findings were reassessed ac- cording to colposcopy triage rules. Results showed 206 women (47%) had no cervical pathology, 165 (37%) had histologically proven minor grade cervical atypia (cervical HPV infection alone, CIN I), 70 (16%) had histologically proven CIN II-III and 2 had invasive cervical car- cinoma. Repeat cytology predicted the presence of minor grade atypia in 53% of cases and major grade disease in 71% of cases. Repeat cytology from both cases of invasive cancer remained nonpredictive. Virapap testing was positive for 76% of minor grade lesions and 82% of major grade lesions. Specific HPV typing will be discussed. One of the invasive cancers was positive on Virapap bu no specific type was determined on Viratype. Twenty-six percent of normal women were positive on Virapap testing. Ninety-two percent of minor grade lesions

were detected by cervicography. Ninety-four percent of major grade lesions were detected as were both invasive cancers. Seven percent of normal women had a “false positive” cervigram. Sensitivity, spec- ificity, and positive predictive values for each screening test are dis- cussed. Recommendation for triage of atypical cytology is presented.

16. High-Dose/Short-Duration Doxorubicinfcis-Platinum Combina- tion Chemotherapy for Advanced Ovarian Epithelial Cancer. RICH-

ARD HUNTER, THOMAS GRIFFIN, SARAH STEVENS, PETER ROSE, AND

FARAN BOKHARI, Departments of Obstetrics and Gynecology and Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts 01655.

Sixty-seven patients with epithelial ovarian cancer were treated with intensive “high-dose/short-course” chemotherapy which consisted of 70 mg/m’ doxorubicin and 120 mg/m* cis-platinum every 3 weeks for four cycles. Doses were not modified for toxicity. At second-look laparotomy patients with minimal residual or no disease were admin- istered either cyclophosphamide (500 mg/m’ every 21 days for six cycles), whole abdominal radiation, or no treatment. The study in- cluded 2 stage IC, 6 stage II, 49 stage III, and 8 stage IV ovarian cancer patients. Forty-three of these patients were debulked to ~19 to >2 cm residual disease after initial surgery. The former showed an increased survival time of 46.9 + 3.7 months as compared to the 22.5 f 4.1 months shown by the latter. At SLL 24 had NED and 24 had macro- or microscopic disease. This treatment was extremely mye- losuppressive with a median nadir WBC of 1300. Thirty-two patients were admitted with febrile neutropenia, 6 developed septicemia, 38 suffered from nausea and vomiting, and 30 had documented peripheral neuropathy. Creatinine levels rose to > 1.5 in 10% of the administered courses. After SLL 18 patients received six courses of cytoxan and 18 whole abdominal radiation. The mean survival time for all the pa- tients was 38.9 +- 3.2 months. Patients with NED at SSL showed a significantly increased mean survival time of 66.6 2 3.9 months (P = 0.0012) over those with micro- or macroscopic SLL (mean survival time 24 months). There was no significant difference between the mean survival times of patients receiving cytoxan, abdominal radiation, or no treatment. Of the 19 long-term survivors (survival > 40 months following diagnosis) 15 had NED and 2 had macroscopic disease.

17. The Role of Surgery in the Management of Gestational Tropho- blastic Disease. WALTER B. JONES AND JOHN L. LEWIS, JR., De- partment of Surgery, Gynecology Service, Memorial Hospital, New York, New York 10021.

Despite the improved prognosis for gestational trophoblastic disease (GTD) patients caused by chemotherapy, a significant number of pa- tients also require major surgery. The surgical indications usually cited include control of bleeding, relief of bowel or urinary obstruction, and resection of residual resistant disease. While many of the procedures such as hysterotomy and hysterectomy are routinely performed by gynecologists, some procedures require the expertise of other surgical specialists. Between 1967 and 1987, 77 of 218 GTD patients (35%) in this study underwent a total of 106 major surgical procedures at some time during their illness. Twenty-one patients underwent two major surgical procedures and in 5 patients, three major procedures were performed. The most frequent operations were hysterectomy, 50/106 (47%), hysterotomy, 13/106 (12%), and thoracotomy, 9/106 (8.5%). Thirty-four procedures ranging in complexity from oophorectomy to segmental liver resection and ctaniotomy were also performed. Five of eight patients (62.5%) who underwent thoracotomy (one patient had the procedure twice) achieved complete remission. Twenty-one op- erations were considered to be beyond the scope of the general gyne- cologist. These data demonstrate that the integration of surgery in the