Small-cell carcinoma of the uterus and the vagina: experience with ten patients.
BACKGROUND
Small cell carcinomas (small-CCs) of the uterine cervix are rare and highly malignant neoplasms. Patients tend to develop distant metastasis early and thus are potential candidates for systemic therapy. We reviewed the experience with small-CCs of the uterus and vagina at two Austrian University hospitals.


METHODS
Ten patients (median age, 50 years; range, 18-92) with small-CC of the cervix (n=7), uterine corpus (n=2), and the vagina (n=1) were treated at the two centers between 1988 and 1998. Eight patients underwent radical surgery, 7 of whom also received chemotherapy. Two additional patients underwent primary radiotherapy.


RESULTS
All Pap smears were suspicious for cervical malignancy. The median survival was 12 months (range, 6-86) and overall 5-year survival was 10%. Five of 8 surgically treated patients had lymph node involvement (62%). Of the 7 patients with small-CC of the cervix only one, who had FIGO stage IIB disease and positive pelvic nodes, survived long-term (86 months) with no evidence of disease. She had received six courses of dose-intensive platinum chemotherapy after radical surgery. All three patients with small-CC of the uterine corpus or vagina developed recurrence within the first year after diagnosis. Of the 7 patients who received chemotherapy, 5 developed progressive or recurrent disease in the paraaortic region (n=2), peritoneum (n=1), liver (n=1), or pelvis (n=1).


CONCLUSIONS
These results confirm the particularly unfavorable prognosis of patients with small-CC of the genital tract. The optimal treatment for these patients most probably including concurrent chemo-radiotherapy remains to be defined.
Petru
Edgar
E
Department of Obstetrics and Gynecology, University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria. edgar.petru@meduni-graz.at
Pasterk
C
C
Reich
O
O
Obermair
A
A
Winter
R
R
Breitenecker
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018288:Carcinoma, Small Cell / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology; D011878:Radiotherapy; D012189:Retrospective Studies; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D014625:Vaginal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*