the same DC-MR images. Flow rates through tumor and muscle tissue were obtained with linear models of the concentration of dye (or intensity of ROI) as a function of time. The ratio of flow rates in tumor to those in normal muscle provided the ETBF. Baseline ETBF differed little with respect to PFS status at six months (median ETBF=2.8 and 2.6, IQR = 3.0, P =0.95). The observed Spearman coefficient of correlation between ETBF and MVD was 0.49 (P = 0.21 and 0.10, two- and one-sided permutation tests, respectively; n =8). Pre- and posttherapy ETBFs appeared to be correlated (r =0.84). The results of the Wilcoxon test suggested an association between changes in ETBF and PFS status. The Hodges–Lehmann estimate of the shift parameter was 0.954 (95% marginal CI= 0.008–2.800). Patients who were progression free at six months tended to have increased ETBFs during therapy (median change = 0.3) compared with those who were not (median change =–0.3). Conclusions: Use of functional imaging to estimate blood flow is a viable research endpoint and deserves further study. The positive correlation observed between ETBF and MVD may become statisti- cally significant in larger studies. Additional studies will determine if increased ETBFs result from stabilization of the tumor vasculature. Consideration of additional imaging time points and monitoring specifically in target lesions may further improve the overall clinical utility of this DC-MRI endpoint. doi:10.1016/j.ygyno.2010.12.157 151 Comparing overall survival in patients with epithelial ovarian, primary peritoneal or fallopian tube cancer who received chemotherapy alone versus neoadjuvant chemotherapy followed by delayed primary debulking R. Correa 1 , S. Dunningan 2 , T. Panzarella 2 , S. Ferguson 2 , K. Murphy 2 , H. Mackay 2 , M. Bernardini 2 1 University Health Network, Toronto, ON, Canada, 2 Princess Margaret Hospital, Toronto, ON, Canada Objective: Neoadjuvant chemotherapy (NAC) is increasingly used for women with advanced-stage epithelial ovarian carcinoma (EOC). If delayed primary surgery occurs, it is usually after three or four cycles of platinum–taxane-based chemotherapy. The aim of this study was to evaluate the effect of surgery on women receiving NAC as opposed to those receiving NAC who did not undergo surgery. We compared the overall survival (OS) of women treated with NAC who underwent surgery and those in whom surgery was not attempted. A retrospective chart review of 290 women in our database undergoing NAC between 1999 and 2008 was undertaken. Following exclusion for nonepithelial histology, primary radiation and loss to follow-up, 182 patients were eligible for analysis. All cases of women who did not undergo surgery (n =51) but met the EORTC criteria for surgical intervention (n =31), as per the recent randomized trial, were reviewed by three gynecologic oncologists. These patients were compared with the NAC patients who underwent delayed primary surgery (n =131). OS was compared using log-rank or Wilcoxon statistics and adjusted for important covariates using a Cox propor- tional hazards model. A comparison between the two groups was also made based on initial response to chemotherapy, with good response defined as a >85% decrease in CA-125 of after three cycles of chemotherapy. Results: Women who underwent surgery after NAC had a signifi- cantly improved OS when compared with those who underwent chemotherapy alone (P =0.0003, HR = 2.18, 95% CI = 1.42–3.35). After adjustment for confounding variables including age at diag- nosis, number of comorbidities and rate of decrease in CA-125, the survival advantage retained only borderline significance (P = 0.052, HR = 1.76, 95% CI = 0.996–3.1). Patients with a >85% reduction in CA- 125 after three cycles of chemotherapy had a significantly better OS compared with those with a reduction ≤ 85% (P = 0.029) regardless of surgical intervention, and among women with a good response to chemotherapy, those who underwent surgery had no survival advantage over those treated with chemotherapy alone (P = 0.48). Conclusions: Following EORTC criteria after NAC, women who undergo surgery have an improved OS compared with women treated with chemotherapy alone. However, the benefit appears to be lost in those women who had a high initial response to chemotherapy as measured by decrease in CA-125. doi:10.1016/j.ygyno.2010.12.158 152 Consolidation paclitaxel is more cost-effective than bevacizumab following upfront treatment of advanced ovarian cancer J. Lesnock 1 , C. Farris 2 , T. Krivak 1 , K. Smith 2 , M. Markman 3 1 Magee–Womens Hospital of UPMC, Pittsburgh, PA, 2 University of Pittsburgh, Pittsburgh, PA, 3 Cancer Treatment Centers of America, Eastern Regional Medical Center, Philadelphia, PA Objective: Standard therapy for advanced epithelial ovarian cancer (EOC) is surgical cytoreduction followed by six cycles of carboplatin and paclitaxel (CT). Randomized, phase III controlled studies have shown significant improvement in progression-free survival (PFS) with consolidation paclitaxel (T) and bevacizumab (B). We sought to evaluate the cost-effectiveness (C/E) of consolidation T versus B in the treatment of advanced EOC. A decision model was developed to compare consolidation strategies. Arm 1 (reference) is six cycles of CT. Arm 2 is six cycles of CT followed by 12 cycles of T (CT+T). Arm 3 is one cycle of CT, five cycles of CTB, and 16 cycles of B (CTB+B). These are based on Gynecologic Oncology Group (GOG) protocols 178 and 218. Para- meters include PFS and overall survival (OS), cost, and quality-of-life utility values. Cost incorporates the reimbursement costs of chemotherapy, administration, complications and surveillance. Modeled complications include neuropathy for T and bowel perforation for B. Key estimates are based on literature and expert opinion, Medicare reimbursement rates, and the Agency for Healthcare Research and Quality Database. The model assumes equal PFS and OS for Arms 2 and 3, recognizing that responses were defined differently in each study and may account for survival differences. Sensitivity analyses were performed to account for uncertainty in assumptions. Results: Cost-effectiveness analysis revealed the incremental cost- effectiveness ratio (ICER) for CT+T is $12,888 per quality-adjusted life-year (QALY) gained compared with CT. For CTB+B compared with CT, the ICER is $326,562/QALY. When all three strategies are compared simultaneously, CTB+ B is dominated, that is, more costly and less effective than CT+T. Sensitivity analyses demonstrated results were robust to PFS variation. At a willingness to pay threshold of $100,000/QALY, CT+T was the preferred option throughout most of the decision space (see figure). CTB+B would become the preferred option if it were to improve OS by 5.6 years over CT+T. Conclusions: In this model, consolidation B following upfront treatment of advanced EOC was associated with a modest improvement in effectiveness that is less than that obtained with consolidation T and more costly. Significant improvement in survival may improve the value of B relative to T. In the current health care environment where costs are S66 ABSTRACTS / Gynecologic Oncology 120 (2011) S2–S133