title: Primary surgery versus primary radiation therapy for FIGO stages I-II small cell carcinoma of the uterine cervix: A retrospective Taiwanese Gynecologic Oncology Group study.
abstract: OBJECTIVE
  To evaluate the role of surgery, radiation therapy and chemotherapy in the management of small cell carcinoma of the uterine cervix (SCCC) through a retrospective study of Taiwanese Gynecologic Oncology Group.
  
  
  METHODS
  We reviewed the medical records and histological files of 144 patients with FIGO stages IA-IIB SCCC treated in 11 main hospitals in Taiwan from 1987 to 2009.
  
  
  RESULTS
  There were 110 patients receiving primary surgery and 34 primary radiation therapy. Most patients in each group also received chemotherapy as part of primary treatment. A lower loco-regional failure rate was observed in patients who received primary radiation therapy than in those who had primary surgery (6% vs. 27%; P=0.009). The 5-year overall survival (OS) was 89% for 13 surgically treated patients with cervical tumor ≤2cm and no lymphovascular space involvement (LVSI) in whom recurrence was noted in 2 of 4 patients without receiving adjuvant chemotherapy and none in the 9 patients who had chemotherapy. Excluding these 13 patients, primary radiation therapy with at least 5cycles of platinum-based chemotherapy (n=14, including 12 stages IB2-IIB) resulted in a 5-year OS of 78%, better than that of 46% by primary surgery (n=97, including 40 stages IB2-IIB) (P=0.046).
  
  
  CONCLUSIONS
  None of the 9 patients with cervical tumor ≤2cm and no LVSI showed disease recurrence after primary surgery and adjuvant chemotherapy. For most patients with stages I-II, primary radiation therapy with aggressive chemotherapy was associated with better survival than surgery.
authors: Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Graduate Institute of Medical Sciences, Taipei Medical University, Taiwan; General Education Center, Tatung University, Taipei, Taiwan.
authors: Tze-Chien
authors: TC
authors: Chen
authors: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University Medical College, Taoyuan, Taiwan.
authors: Huei-Jean
authors: HJ
authors: Huang
authors: Department of Pathology, Mackay Medical College and Mackay Memorial Hospital, New Taipei City, Taiwan; Mackay Medicine, Nursing and Management College, New Taipei City, Taiwan.
authors: Tao-Yeuan
authors: TY
authors: Wang
authors: Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
authors: Lan-Yan
authors: LY
authors: Yang
authors: Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
authors: Chi-Hau
authors: CH
authors: Chen
authors: Department of Obstetrics Gynecology, National Cheng Kung University, Tainan, Taiwan.
authors: Ya-Min
authors: YM
authors: Cheng
authors: Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors: Wen-Hsiung
authors: WH
authors: Liou
authors: Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Shih-Tien
authors: ST
authors: Hsu
authors: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Kuo-Chang
authors: KC
authors: Wen
authors: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
authors: Yu-Che
authors: YC
authors: Ou
authors: Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.
authors: Yao-Ching
authors: YC
authors: Hung
authors: Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Hung-Cheng
authors: HC
authors: Lai
authors: Gynecologic Cancer Center, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Hsinchuang, New Taipei City, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Chih-Ming
authors: CM
authors: Ho
authors: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University Medical College, Taoyuan, Taiwan. Electronic address: tinchang.chang@gmail.com.
authors: Ting-Chang
authors: TC
authors: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018288:Carcinoma, Small Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013624:Taiwan; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*
keywords: Cervical cancer; Platinum-based chemotherapy; Radiation therapy; Radical hysterectomy; Small cell carcinoma