Volume 84  Number 3S  Supplement 2012 Oral Scientific Sessions S95

17.6%), compared to other cancers (8.4%, 95% CI 5.7-11.1%), cardiovas- deviation 0.70 cm. Ninety percent of medial nodes were within 2.77 cm, and
cular disease (7.3%, 95% CI 4.7-9.9%), and all other causes (10.4%, 95% CI 95% were within 3.09 cm of the nearest vessel. The lateral distance from the
7.2-13.6%). On univariate analysis, older age, CS  1, and # pack-years vessel center to the nearest node ranged from 0.16-4.58 cm, with a median of
smoked were significant factors predictive of OS, while Gleason score, T 1.81 cm, mean 1.90 cm, and standard deviation 1.04 cm. Ninety percent of
stage, PSA, duration of AD, radiation dose, and body mass index were not. lateral nodes were within 4.06 cm, and 95% were within 4.40 cm of the
On multivariate analysis, older age (HR Z 1.61, p Z 0.001) and CS  1 (HR nearest vessel. There were no nodes located posterior to the vessels. The
Z 2.08, p < 0.0001) remained statistically significant for increased risk of inguinal nodes were bound anteriorly by the sartorius, posteriorly by the
mortality. Men younger than 70 years of age with a CS Z 0 were more likely anterior aspect of the iliopsoas or pectineus, medially by the medial third of
to die of prostate cancer than any other cause, whereas older men or those the pectineus, and laterally by the lateral aspect of the sartorius muscles.
with CS  1 more commonly suffered non-prostate cancer death (Table). Conclusions: The majority of inguinal lymph nodes lay anteromedial to
The cumulative incidences of prostate cancer-specific mortality were the femoral vessels. A uniform margin of 0.7-0.8 cm around the vessels is
similar regardless of age or co-morbidities (p Z 0.60). insufficient to include most of the nodes. In order to cover 90% of nodes,
Conclusions: Men with high risk prostate cancer are more likely to die of a margin of 3.37 cm anteriorly, 2.77 cm medially, and 4.06 cm laterally
causes other than their prostate cancer, except for the subgroup of men from the vessels should be applied. Nearby muscles can also be helpful in
under 70 years of age without co-morbidities, in whom more aggressive determining the anatomical boundaries of the nodes.
therapy is worthy of further investigation. Only older age and existence of Author Disclosure: H. Yoon: None. I.B. Helenowski: None. J.B. Strauss:
co-morbidities significantly predicted for OS, whereas prostate cancer- and None. V. Sathiaseelan: None. W. Small: None.
treatment-related factors did not.

Oral Scientific Abstract 232; Table Mortality by age and Charlson score (CS)
234
10-yr all-
cause 10-yr prostate The Prognostic Significance of Human Papilloma Virus and P16 in
Group mortality 95% CI cancer mortality 95% CI Patients With Vulvar Squamous Cell Carcinoma Treated With
Age <70, CS Z 0 26.0% 18.6-33.5% 16.9% 10.6-23.2% Radiation Therapy
(n Z 244) M. Yap,1,2 J. Cuartero,1,2 G. Allo,1,2 M. Pintilie,1,2 K. Opfermann,1,2
Age <70, CS > Z 1 50.1% 37.0-63.3% 12.7% 4.7-20.7% A. Fyles,1,2 J. Murphy,1,2 S. Kamel-Reid,1,2 B. Clarke,3,2 and
(n Z 108) M. Milosevic1,2; 1Princess Margaret Hospital, Toronto, ON, Canada,
Age > Z 70, CS Z 0 37.8% 27.9-47.6% 12.3% 6.0-18.6% 2
(n Z 182) University of Toronto, Toronto, ON, Canada, 3Toronto General Hospital,
Age > Z 70, CS > Z 65.0% 53.1-76.8% 12.4% 5.7-19.1% Toronto, ON, Canada
1 (n Z 126)
p value <0.0001 0.60 Purpose/Objective(s): Human papilloma virus (HPV) has been identified
as an etiological agent in a subset of patients with vulval squamous cell
carcinoma (VSCC). The prognostic and predictive role of HPV status in
Author Disclosure: R.D. Tendulkar: None. G.K. Hunter: None. C.A. Reddy: women treated with radiation therapy (RT) in VSCC has not yet been
None. K.L. Stephans: None. J.P. Ciezki: None. A.J. Stephenson: None. E.A. determined. We investigated the associations between HPV, p16, and p53
Klein: None. A. Mahadevan: None. P.A. Kupelian: None. status and clinical outcome in these women.
Materials/Methods: Patients treated with curative intent for VSCC at
233 a single institution from 2000 to 2008 were retrospectively identified.
Contouring Guidelines of the Inguinal Lymph Nodes Using Those who received definitive or adjuvant RT as part of the treatment
Lymphangiograms for the Delivery of Radiation Therapy in regimen, and who had available pathological specimens, were included for
Gastrointestinal, Gynecological, and Genitourinary Cancers analysis. HPV infection was detected using Roche Linear array hybrid-
H. Yoon, I.B. Helenowski, J.B. Strauss, V. Sathiaseelan, and W. Small; ization and p16 and p53 immunohistochemistry performed on tissue
Northwestern University Medical School Affiliated Hospitals, Chicago, IL microarray. Five year overall survival (OS) and disease-free survival (DFS)
were analyzed using the Kaplan-Meier method. Log-rank tests were used
Purpose/Objective(s): Inguinal lymph nodes are treated with radiation for univariate analyses, and the Cox proportional hazards model for
therapy in anal, distal rectal, vulvar, vaginal, testicular, urethral, and penile multivariate analysis. The risk of recurrence (RR) was estimated using
cancers. The RTOG atlas for anorectal cancer provides a consensus on the cumulative incidence function and Gray’s test, and the Fine and Gray
cephalad-caudal boundaries on contouring the inguinal lymph node CTV model used for multivariate analysis.
from the upper edge of the superior pubic rami to 2 cm below the Results: Forty-four patients were suitable for analysis, with a median age of
saphenous/femoral junction, with a margin of 0.7-0.8 cm around the 69 years. Thirty patients (70%) were staged as T1 (AJCC TNM 7.0), the
femoral vessels. The purpose of this project is to identify the location of remainder T2-3. Twenty-three patients (53%) had clinically and/or patho-
the inguinal lymph nodes on lymphangiogram and determine how far the logically involved lymph nodes at diagnosis. Management regimens
inguinal lymph nodes lie relative to the femoral vessels. included: RT alone (n Z 2); RT and chemotherapy (n Z 5); RT and resection
Materials/Methods: Five patients with cervical cancer underwent (n Z 16); and RT, chemotherapy and resection (n Z 21). Median RT dose
lymphangiograms prior to CT simulation for radiation therapy. Four out of was 50.0 Gy and median follow-up was 4.9 years. HPV was detected in 17/44
five patients were positioned prone. The distance from the center of the (39%) patients, HPV16 being the most common serotype (76%). Expression
vessel to the farthest edge of the nearby node was measured bilaterally on of p16 (p Z 0.001) and loss of p53 (p Z 0.03) were associated with HPV
each 3 mm CT slice, from the top of the femoral heads down to the infection. For all patients, OS and DFS estimates at 5 years were 52% and
saphenous/femoral junction. 30% respectively. P16 positive patients (n Z 13) had better DFS compared
Results: A total of 212 measurements were taken, 41 from the first patient, with p16 negative patients (n Z 30), 66% versus 12% (p Z 0.005). This
45 from a second, 38 from a third, 45 from a fourth, and 43 from a fifth. A total result remained significant on multivariate analysis (HR Z 0.22, CI 0.07-
of 83.47% of nodes were located anterior to the femoral vessels, 67.36% 0.73, p Z 0.01) when accounting for pathological tumor depth (p Z 0.001).
medial, and 57.44% lateral. The anterior distance from the vessel center to HPV positive patients had reduced RR compared to HPV negative patients,
the nearest node ranged from 0.68-3.88 cm, with a median of 2.68 cm, mean 23.5% versus 81.7% (p Z 0.005) and this remained significant on multi-
2.55 cm, and standard deviation 0.67 cm. Ninety percent of anterior nodes variate analysis (HR Z 0.2, CI 0.06-0.71, p Z 0.01) when accounting for
were located within 3.37 cm, and 95% were within 3.62 cm of the nearest tumor depth (p Z 0.001) and use of surgery (p Z 0.008). Similarly, P16
vessel. The medial distance from the vessel center to the nearest node ranged expression was associated with reduced RR on multivariate analysis (HR Z
from 0.27-3.18 cm, with a median of 1.87 cm, mean 1.77 cm, and standard 0.2, CI 0.05-0.76, p Z 0.02).