Treatment of the Early Stage Small Cell Carcinoma of the Cervix

Yun, Kyung Ho; Kim, Dae Kon; Moon, Myung Jin; Kim, Soo Jung; Seong, Seok Ju; Lim, Kyung Taek; Lee, Ki Heon; Shim, Jae Wook; Park, Chong Taek

Abstract

OBJECTIVE
Small cell carcinoma of the cervix(SCC) is a rare aggressive tumor with a propensity for rapid distant recurrence and a high mortality rate. The purpose of this study was to review our experience in early stage disease and to perform a meta-analysis of the literature to compare neoadjuvant with adjuvant chemotherapy as prognostic factor.
METHODS
Between 1990 and 1998, seven women with FIGO early stage(IB-IIA) SCC were treated with surgery and chemotherapy at our hospital. Medical records were retrospectively reviewed. And thirty-two early-stage SCC patients who similarly treated since 1990 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
Out of our patients, three patients died at 12-13 months after diagnosis due to distant metastases which were brain in two and was liver and lung in one. Other three are alive with no evidence of disease at 27, 66, and 121 months. From the meta-analysis, the overall 3-year survival rate was 49% in neoadjuvant and 33% in adjuvant chemotherapy, but there were no statistical significance.(log-rank test, 0.80) Neoadjuvant chemotherapy resulted in a high response rates(81.2%), no pelvic recurrence, and a low LN metastasis(18.8%), therefore the pelvic radiation therapy rates was low.
CONCLUSIONS
Even in the early stage, SCC treatment must be combined with chemotherapy. There was no significant difference in prognosis between neoadjuvant and adjuvant chemotherapy. But this study showed neoadjuvant may extirpate the primary lesion, evaluate response, and assess more promising postoperative therapy according to pathologic features.