SOCIETY OF GYNECOLOGIC ONCOLOGISTS-ABSTRACTS 263

and recurrence. For the patients with G3 lesions and outer one-third myometrial invasion, the incidence is: pelvic node metastases-stage IA 30%, stage IB 41.7%, stage II 55.6%; aortic nodes- stage IA IS%, stage IB 20.8%, stage II 44.4%; adnexal spread-stage IA 15%. stage IB 20.8%. stage II 11.1%, positive peritoneal cytology-stage IA 20%, stage IB 29.2%, stage 11 1 I. I%. The 2-year recurrence rate is 9.7%.

26. Intestinal Surgery in Advanced Epithelial Ovurian Carcinoma: The Mayo Clinic Experience 1961-1980. RAYMOND M. LUPSE, M.D., PH.D., RICHARD E. SYMMONDS, M.D., KARL C. PODRATZ, M.D., PH.D., AND PETER C. O’BRIEN, PH.D., Mayo Clinic, 200 First Street, SW, Rochester, Minnesota 55901.

The purpose of this study was to determine whether interruption of the intestinal tract for removal of metastases improves survival in patients with advanced epithelial ovarian carcinoma. From 1961 to 1980, one hundred ninety-two patients underwent intestinal surgery in order to achieve maximum cytoreduction of tumor. Statistical methods included log-rank tests and Cox regression analysis. The protocols used evaluated (1) the use and results of intestinal surgery performed either at the time of, or subsequent to, initial debulking, and (2) subsequent follow-up of these patients. Twenty-one (10.9%) patients died within 60 days of intestinal surgery. Of 171 patients who survived, 127 (74.3%) died of disease but survived a mean of 17.8 months (longest survival 164 months). Fourteen (8.2%) patients who remain alive with no evidence of disease have survived a mean of 104 months (range: 23-243 months). These data indicate that (I) those patients who had no tumor residual after intestinal surgery had a much higher survival rate than those who did (P < 0.001); and (2) survival was greater in those patients who had maximum tumor reduction (P < 0.001). Interruption of the intestinal tract to achieve maximum tumor cytoreduction in advanced epithelial ovarian carcinoma is warranted.

27. The Syed-Neblett Interstitial Template in Locally Advanced Gynecological Malignancies. FRANCXO AMPUERO, M.D., University of New Mexico Medical Center, Albuquerque, New Mexico 87131.

Twenty-eight patients with locally advanced malignancies of the cervix and vagina were treated with a combination of external radiation therapy and afterloading Syed-Neblett iridium template. There were 22 patients with squamous cell cancer and two patients with adenocarcinomas of the cervix. Four patients with squamous cell cancer of the vagina were treated with this method. Only patients with locally advanced disease (cervical lesion >4 in diameter) and poor vaginal anatomy were selected for this modality of therapy. In our series the incidence of distant failures of 39% seems to confirm the significance of local volume of disease as a prognostic indicator; despite a local control rate of 49%, only 33% of our patients are alive from 25 to 51 months. Complications occurred in 12 patients (42%). Six patients (22%) developed severe rectal stricture or rectovaginal fistula necessitating diverting sigmoid colostomy; five patients (18%) developed hemorrhagic proctitis with diarrhea and tenesmus; one patient developed vaginal vault necrosis. Complications occurred 7 to 24 months following therapy. Six of the twelve patients developing complications are dead of disease. On the basis of this study and because of the low cure rate and high incidence of complications, the value of the Syed-Neblett template in locally advanced gynecologic malignancies should be reconsidered.

28. Survival and Patterns of Recurrence in Cervical Cancer Metastatic to Periaortic Lymph Nodes (A Gynecologic Oncology Group Study). MICHAEL L. BERMAN, M.D., AND PHILIP J. DISAIA, M.D., University of California, Irvine Medical Center, 101 City Drive, Orange, California 92668; HENRY KEYS, M.D., University of Rochester Medical Center, Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, New York 14642; WILLIAM T. CREASMAN, M.D., Duke University Medical Center, Durham, North Carolina 27710; JOHN BLESSING, PH.D., AND BRIAN BUNDY, M.A., COG Statistical Office, Roswell Park Memorial Institute, 666 Elm Street, Buffalo, New York 14263.

Ninety-eight of six hundred twenty-one evaluable patients (16%) with cervical cancer enrolled into Gynecologic Oncology Group protocols were found to have periaortic lymph node metastases at staging laparotomy or at exploration for definitive operative management. As expected there was a progressive increase in the prevalence of periaortic metastases including 5% of 150 patients with