Tohoku J. Exp. Med., 2013 Jan, 229(1)

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

HIDEKI TOKUNAGA,¹ SATORU NAGASE,¹ KOSUKE YOSHINAGA,¹ SOTA TANAKA,¹ TOMOYUKI NAGAI,¹ HIROKI KUROSAWA,¹ MICHIKO KAIHO-SAKUMA,¹ MASAFUMI TOYOSHIMA,¹ TAKEO OTSUKI,¹ HIROKI UTSUNOMIYA,¹ TADAO TAKANO,¹ HITOSHI NIIKURA,¹ KIYOSHI ITO¹ and NOBUO YAEGASHI¹

¹Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan

Small cell carcinoma of the uterine cervix (SCCC) is a rare subtype of cervical cancer with an aggressive behavior. Although SCCC has a worse prognosis than other histological types of uterine cervical cancer such as squamous cell carcinoma or adenocarcinoma, standard therapy for SCCC remains to be established due to its rarity. The purpose of this study was to evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) using a regimen consisting of vincristine, adriamycin, and cyclophosphamide alternating with cisplatin and etoposide (VAC/PE). We analyzed a series of 9 patients with SCCC. Five patients with stage IB disease underwent radical hysterectomy followed by CCRT. Four patients with advanced stage disease received CCRT primarily. With a median follow-up duration of 47.4 months (range, 10.5 to 86.4 months), 4 out of 5 patients with stage IB disease were alive without recurrence. In 4 patients with advanced stage disease, the response rate was 75% (complete response, 1; partial response, 2; progressive disease, 1). One patient with stage IVB disease remained without recurrence for 89.5 months. At 5 years, overall survival (OS) and progression-free survival for all patients was 52% and 56%, respectively. Patients with early-stage disease had an 80% 5-year OS rate compared to 25% for patients with advanced stage disease. Although all patients developed grade 3-4 neutropenia, CCRT using VAC/PE is feasible in both the primary and adjuvant settings for SCCC. In particular, this combined modality therapy may improve both local control and survival as postoperative treatment in patients with early-stage disease.

keywords —— concurrent chemoradiotherapy; neuroendocrine carcinoma; small cell carcinoma of the uterine cervix; uterine cervical cancer; VAC/PE

©2013 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2013, 229, 75-81

Correspondence: Satoru Nagase M.D., Ph.D., Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: nagases@med.tohoku.ac.jp