Multimodality therapy in early-stage neuroendocrine carcinoma of the uterine cervix

Objective. Patients with early-stage neuroendocrine cervical carcinoma (NECC) have a high mortality rate despite aggressive therapy. The rarity of this tumor precludes initiation of a randomized, prospective trial. We reviewed our experience in early stage disease and performed a meta-analysis of the literature to identify prognostic factors and determine optimal multimodality therapy. Methods. Eleven women with International Federation of Gynecology and Obstetrics (FIGO) early stage (IB-IIA) NECC were treated with surgery and chemotherapy at our institutions between 1978 and 1998, Administration of radiation therapy was recorded, but not required for inclusion in this study. A gynecologic pathologist reviewed all histopathologic sections. Medical records were retrospectively reviewed and clinical data obtained. Twenty-three early-stage NECC patients who were similarly treated during the study interval were identified by a Medline search of the English literature and included in the analysis. The Kaplan-Meier method and log-rank test were used for survival analysis. Results. The overall 2-year survival rate for the 34 patients was 38%. The median age was 37 years (range, 20-75 years). Median cervical tumor diameter was 3.2 cm (range 0.5-11.0 cm), Lymphovascular space invasion was present in 21 (78%) of 27 patients (7 unknown). Fifteen (52%) of twenty-nine had lymph node metastases (5 unknown). Fifteen patients received postoperative platinum/etoposide (PE), seven received vincristine/adriamycin/cyclophosphamide (VAC), two received alternating cycles of VAC and PE, and ten received other chemotherapy regimens. Twenty women were treated with radiation therapy. The presence of lymph node metastases was a poor prognostic factor (P < 0.001), PE and VAC chemotherapy was associated with increased survival (P < 0.01). Conclusion. NECC is a highly lethal variant of cervical cancer. The presence of lymph node metastases is the most important prognostic variable. Postoperative VAC or PE appears most likely to improve chances for survival, (C) 2001 Academic Press.