Small cell carcinoma of vulva: curative multimodal treatment in face of resistance to initial standard chemotherapy.
OBJECTIVE
Extrapulmonary small cell carcinoma (EPSCC) is a rare disease, which has a slightly better prognosis than small cell lung cancer, but still dismal. Gynecologic small cell malignancies tend to show a better survival than similar histologies of other regions. However, of five reported cases of vulvar manifestation only one patient was disease-free at the time of publication with limited follow-up.


METHODS
The authors describe a case of locally advanced small cell vulva carcinoma infiltrating the anal sphincter and urethra with spread to inguinal lymph nodes treated by radiochemotherapy and regional hyperthermia. After three cycles of carboplatin/ etoposide, computed tomography and magnetic resonance imaging indicated only little regressive transformations but overall stable disease. Surgical options were excluded. Therefore, curative radiotherapy to a total dose of > 65 Gy to macroscopic tumor, chemotherapy with cisplatin weekly, and regional hyperthermia were performed. Acute severe toxicity was limited to skin reactions. Despite the disadvantageous situation with inguinal lymph node metastases and chemoresistance, the multimodal therapy yielded a 5-year disease-free survival.


CONCLUSIONS
Thus, the trimodal regimen of radiochemotherapy plus regional hyperthermia offered a curative chance in spite of resistance to the standard chemotherapy for irresectable, locally advanced small cell carcinoma of the vulva. Therefore, this approach merits further evaluation for limited disease of EPSCC.
Eckert
Franziska
F
Department of Radiooncology, Eberhard Karls University of Tübingen, Tübingen, Germany.
Fehm
Tanja
T
Bamberg
Michael
M
Müller
Arndt-Christian
AC
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008279:Magnetic Resonance Imaging; D011859:Radiography; D014055:Tomography, Emission-Computed; D014846:Vulvar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*
D005047:Etoposide; D016190:Carboplatin
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