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Multimodal Management of Locally Advanced Neuroendocrine Cervical Carcinoma: A Single Institution Experience
  1. Pauline Castelnau-Marchand, MD*,
  2. Patricia Pautier, MD,
  3. Catherine Genestie, MD,
  4. Alexandra Leary, MD, PhD,
  5. Enrica Bentivegna, MD§,
  6. Sébastien Gouy, MD, PhD§,
  7. Jean-Yves Scoazec, MD, PhD,
  8. Philippe Morice, MD, PhD§,
  9. Christine Haie-Meder, MD* and
  10. Cyrus Chargari, MD, PhD*,,#
  1. * Brachytherapy Unit, Radiation Oncology,
  2. Departments of Medical Oncology,
  3. Pathology, and
  4. § Surgery, Gustave Roussy, Villejuif;
  5. Université Paris Sud XI, Faculté de Médecine de Bicêtre, Le Kremlin-Bicêtre;
  6. French Military Health Services Academy, Ecole du Val-de-Grâce, Paris; and
  7. # Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France.
  1. Address correspondence and reprint requests to Pauline Castelnau-Marchand, MD, Gustave Roussy Cancer Campus, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France. E-mail: Pauline.castelnau.marchand{at}gmail.com.

Abstract

Objective The aim of this study was to report our institutional experience of a multimodal approach for treatment of locally advanced high-grade neuroendocrine cervical cancer.

Methods and Materials Patients with primary locally advanced neuroendocrine cervical cancer diagnosed between 2001 and 2014 were included. The scheduled treatment sequence was as follows: pelvic +/− para-aortic radiotherapy (according to tumor stage), associated with chemotherapy based on platine-derivate and etoposide regimen, followed with a brachytherapy boost, then completion surgery if there was no progression +/− consolidation etoposide chemotherapy (for a total of 5–6 cycles). Disease-free survival (DFS) and overall survival (OS) were reported and prognostic factors were searched.

Results A total of 24 patients fulfilled inclusion criteria. Median age was 48 (range 22–77 years). Fourteen patients (58%) had pelvic lymph node metastases. After chemoradiation/brachytherapy, a radical hysterectomy could be performed in 18 of 24 patients (75%). Histologically complete resection was achieved in 14 (78%) of 18 patients. Complete pathological response was reported in 7 (39%) of 18. With median follow-up of 29.7 months, 10 (42%) of 24 patients experienced tumor relapse, all associated with distant failure, including one local failure. The DFS and OS rates estimated at 3 years were 55% and 63%, respectively. Lymph node metastases and tumor stage were prognostic for DFS (P = 0.016 and P = 0.022, respectively). Complete resection was associated with a lower incidence of relapses, as compared with microscopically incomplete resection (P = 0.04). A total of 12 (86%) of 14 patients with histologically complete resection were in complete remission at last follow-up. Apart from manageable acute hematological toxicities, most treatment complications were mild to moderate.

Conclusions This series based on a multimodal management compares favorably with previously published data. Most patients could be eligible to surgery, and complete remission was achieved in 85% of those amenable to complete resection.

  • Neuroendocrine tumor
  • Cervical cancer
  • Brachytherapy
  • Hysterectomy
  • Chemotherapy

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Footnotes

  • The authors declare no conflicts of interest.

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