PROGNOSTIC FACTORS IN SURGICALLY TREATED SMALL-CELL CERVICAL-CARCINOMA FOLLOWED BY ADJUVANT CHEMOTHERAPY

BACKGROUND, Small cell carcinoma of the uterine cervix is an uncommon tumor associated with high mortality even among patients with early st age disease. The role of adjuvant chemotherapy after surgery has been suggested by regimens used for small cell lung carcinoma. During the y ears 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 consecutivel y to 23 patients with Stage Ib-II small cell cervical carcinoma who ha d been primarily treated with radical hysterectomy and had adequate bo ne marrow, renal, and hepatic functions. A combination of vincristine, doxorubicin, and cyclophosphamide alternating with cisplatin and etop oside (VAC/PE) was administered to 14 patients during the years 1988-1 996 according to a prospective study protocol. A combination of cispla tin, vinblastine, and bleomycin (PVB) was administered to 8 patients, and another regimen was administered to 1 patient during the years 198 4-1988. Prognostic factors were evaluated by analyzing both the data o n these 23 patients and the pooled data on the cases retrieved from th e literature and our own files. RESULTS, Ten of the 14 patients who re ceived 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 surv ived. Of the 10 patients who died of their disease, all died of distan t metastasis within 10 months after recurrence. Meta-analysis of the p ooled data showed that 68% of patients who received regimens containin g VAC or PE survived, whereas 33% of patients who received regimens no t containing VAC/PE survived (P = 0.0078, log rank test). Seventy perc ent 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 con taining VAC or PE are favorable regimens for patients with early stage small cell cervical carcinoma after radical hysterectomy. Cancer 1998 ;83:712-8. (C) 1998 American Cancer Society.