title: Small cell carcinoma of the uterine cervix: clinical outcome of concurrent chemoradiotherapy with a multidrug regimen.
abstract: Small cell carcinoma of the uterine cervix (SCCC) is a rare subtype of cervical cancer with an aggressive behavior.  Although SCCC has a worse prognosis than other histological types of uterine cervical cancer such as squamous cell carcinoma or adenocarcinoma, standard therapy for SCCC remains to be established due to its rarity.  The purpose of this study was to evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) using a regimen consisting of vincristine, adriamycin, and cyclophosphamide alternating with cisplatin and etoposide (VAC/PE).  We analyzed a series of 9 patients with SCCC.  Five patients with stage IB disease underwent radical hysterectomy followed by CCRT.  Four patients with advanced stage disease received CCRT primarily.  With a median follow-up duration of 47.4 months (range, 10.5 to 86.4 months), 4 out of 5 patients with stage IB disease were alive without recurrence.  In 4 patients with advanced stage disease, the response rate was 75% (complete response, 1; partial response, 2; progressive disease, 1).  One patient with stage IVB disease remained without recurrence for 89.5 months.  At 5 years, overall survival (OS) and progression-free survival for all patients was 52% and 56%, respectively.  Patients with early-stage disease had an 80% 5-year OS rate compared to 25% for patients with advanced stage disease.  Although all patients developed grade 3-4 neutropenia, CCRT using VAC/PE is feasible in both the primary and adjuvant settings for SCCC.  In particular, this combined modality therapy may improve both local control and survival as postoperative treatment in patients with early-stage disease.
authors.affiliation: Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Tokunaga
authors.forename: Satoru
authors.initials: S
authors.lastname: Nagase
authors.forename: Kosuke
authors.initials: K
authors.lastname: Yoshinaga
authors.forename: Sota
authors.initials: S
authors.lastname: Tanaka
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nagai
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kurosawa
authors.forename: Michiko
authors.initials: M
authors.lastname: Kaiho-Sakuma
authors.forename: Masafumi
authors.initials: M
authors.lastname: Toyoshima
authors.forename: Takeo
authors.initials: T
authors.lastname: Otsuki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Tadao
authors.initials: T
authors.lastname: Takano
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Niikura
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ito
authors.forename: Nobuo
authors.initials: N
authors.lastname: Yaegashi
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000379:methods*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D023381:Endpoint Determination; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone