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

Objective. Patients with early-stage neuroendocrine cervical carcinoma (NEC C) have a high mortality rate despite aggressive therapy. The rarity of thi s tumor precludes initiation of a randomized, prospective trial. We reviewe d our experience in early stage disease and performed a meta-analysis of th e literature to identify prognostic factors and determine optimal multimoda lity therapy. Methods. Eleven women with International Federation of Gynecology and Obste trics (FIGO) early stage (IB-IIA) NECC were treated with surgery and chemot herapy at our institutions between 1978 and 1998, Administration of radiati on therapy was recorded, but not required for inclusion in this study. A gy necologic pathologist reviewed all histopathologic sections. Medical record s were retrospectively reviewed and clinical data obtained. Twenty-three ea rly-stage NECC patients who were similarly treated during the study interva l were identified by a Medline search of the English literature and include d 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 diamete r 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 l ymph node metastases (5 unknown). Fifteen patients received postoperative p latinum/etoposide (PE), seven received vincristine/adriamycin/cyclophospham ide (VAC), two received alternating cycles of VAC and PE, and ten received other chemotherapy regimens. Twenty women were treated with radiation thera py. 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 presenc e of lymph node metastases is the most important prognostic variable. Posto perative VAC or PE appears most likely to improve chances for survival, (C) 2001 Academic Press.