Prognostic factors in surgically treated small cell cervical carcinoma followed by adjuvant chemotherapy

Abstract

BACKGROUND Small cell carcinoma of the uterine cervix is an uncommon tumor associated with high mortality even among patients with early stage disease. The role of adjuvant chemotherapy after surgery has been suggested by regimens used for small cell lung carcinoma. During the years 1980‐1997, 19 cases in which various adjuvant chemotherapies were given after hysterectomy were reported in the literature published in English. METHODS Adjuvant chemotherapy was administered consecutively to 23 patients with Stage Ib‐II small cell cervical carcinoma who had been primarily treated with radical hysterectomy and had adequate bone marrow, renal, and hepatic functions. A combination of vincristine, doxorubicin, and cyclophosphamide alternating with cisplatin and etoposide (VAC/PE) was administered to 14 patients during the years 1988‐1996 according to a prospective study protocol. A combination of cisplatin, vinblastine, and bleomycin (PVB) was administered to 8 patients, and another regimen was administered to 1 patient during the years 1984‐1988. Prognostic factors were evaluated by analyzing both the data on these 23 patients and the pooled data on the cases retrieved from the literature and our own files. RESULTS Ten of the 14 patients who received VAC/PE had no evidence of disease during a median follow‐up of 41 months, whereas 3 of the 9 who received PVB or another regimen survived. Of the 10 patients who died of their disease, all died of distant metastasis within 10 months after recurrence. Meta‐analysis of the pooled data showed that 68% of patients who received regimens containing VAC or PE survived, whereas 33% of patients who received regimens not containing VAC/PE survived (P = 0.0078, log rank test). Seventy percent of patients with no lymph node metastasis at hysterectomy and 35% with lymph node metastasis survived (P = 0.05). All patients who died of disease had extrapelvic metastasis. CONCLUSIONS Chemotherapies containing VAC or PE are favorable regimens for patients with early stage small cell cervical carcinoma after radical hysterectomy. Cancer 1998;83:712‐718. © 1998 American Cancer Society.

Primary Neuroendocrine Carcinoma of the Uterine Cervix Treated With Complete Surgical Resection and Adjuvant Combination Chemotherapy

“…Thus, the investigation on the treatment of cervical neuroendocrine carcinoma is usually considered based on the clinical data of cervical SCNC, or more generally, of lung SCNC. For cervical SCNC, Chang et al reported superior survival with the adjuvant combination chemotherapy of vincristine, doxorubicin and cyclophosphamide (VAC), or of cisplatin and etoposide (PE) [21]. Lee et al concluded that there was no difference in 5-year survival of cervical SCNC between the adjuvant chemotherapy and the adjuvant chemoradiotherapy [22].…”

Small Cell Carcinoma of the Uterine Cervix: Clinical Outcome of Concurrent Chemoradiotherapy with a Multidrug Regimen

“…Many authors have recommended adjuvant chemotherapy due to the aggressive behavior of this tumor (Chang et al 1998;Boruta et al 2001); however, it is difficult to perform a large scale randomized controlled study given the rarity of the condition. The Gynecologic Oncology Group attempted to study small cell cervical carcinoma in protocol 66 between 1982 and 1986, but failed to recruit sufficient numbers of patients.…”

“…Although irradiation improves both the local control and survival rates in SCLC patients (Warde and Payne 1992), chemotherapy has historically been the cornerstone of SCLC management. Chang et al attempted to treat SCCC in a fashion similar to that used in SCLC, and reported a 5-year overall survival (OS) of 68% (n = 28) for patients treated with vincristine, adriamycin, and cyclophosphamide alternating with cisplatin and etoposide (VAC/ PE) compared to 33% (n = 12) for patients who received a regimen consisting of cisplatin, vinblastine, and bleomycin (Chang et al 1998). In another small phase II trial of alternating VAC/PE in early-stage SCCC before hysterectomy, 6 of 7 patients experienced a clinical complete response (CR) (Chang et al 1999).…”

Small Cell Carcinoma of the Uterine Cervix Misdiagnosed as Squamous Cell Carcinoma

“…Also, adjuvant chemotherapy provides a significant survival advantage for patients either with or without lymph node metastasis (Gardner, 2011). Chemotherapy regimens are extrapolated from those used in small cell carcinoma of the lung, and are based either on vincristine/adriamycin/ cyclophosphamide (VAC) or cisplatin/etoposide (EP) (Chang, 1998;Boruta, 2001). However, EP regimens are www.ccsenet.org/cco Cancer and Clinical Oncology Vol.…”