title: Effects and toxicity of neoadjuvant chemotherapy preoperative followed by adjuvant chemoradiation in small cell neurdendocrine cervical carcinoma.
abstract: OBJECTIVE
  To determine the efficacy and toxicity of a combined-modality regimen of neoadjuvant chemotherapy (NACT) before primary radical surgery followed by adjuvant chemoradiation in small cell neuroendocrine cervical cancer (SCNEC) patients.
  
  
  METHODS
  The study was approved by the ethics committee of the present hospital. The records of 23 SCNEC patients who received NACT before primary radical surgery were reviewed at the Zhejiang Cancer Hospital between January 1998 and May 2010. All patients received one to four cycles of NACT and two to eight cycles of chemotherapy (NACT and adjuvant chemotherapy) on the basis of platinum, 17 (73.9%) patients received NACT using a regimen consisting of etoposide and cisplatin (EP). Eighteen (85.7%) patients received adjuvant chemotherapy using a regimen consisting of PE and EP. Kaplan-Meier and Cox regression methods were used for analyses.
  
  
  RESULTS
  Of the 23 eligible patients, 18 had Stages I-IIA, five had Stages IIB-IIIB disease. Twelve patients (52.2%) developed grade 3 and 4 neutropenia. Fourteen patients (60.9%) developed grade 3 and 4 anemia. The majority of grade 3 and 4 neutropenia and non-hematologic toxicities were usually self-limited. Three patients (13.0%) who postoperative pathology showed pathologic complete response (CR) had better prognosis than those did not show pathologic CR; the median survival was 69.5 months (range, 51.1-177.1), 54.5 months (range: 7.3-81.5), respectively. In univariate analysis, lymphovascular space invasion (LSI) (p = 0.013), and deep stromal invasion (DSI) (p = 0.001) were considered poor prognostic factors. With a median follow-up for surviving patients was 40.8 months (range, 7-177), 12 patients recurred, 11 of which had died. The estimated three- and five-year overall survival (OS) rates for all patients were 55.8% and 39.9%, respectively.
  
  
  CONCLUSIONS
  NACT before primary radical surgery followed by adjuvant chemoradiation or chemotherapy was well tolerated and seems to be effective for early stage SCNEC patients. Prospective clinical study is necessary and we hope that this research's results help to design a prospective clinical study.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Yin
authors.forename: A J
authors.initials: AJ
authors.lastname: Yu
authors.forename: M J
authors.initials: MJ
authors.lastname: Wu
authors.forename: J
authors.initials: J
authors.lastname: Fang
authors.forename: L F
authors.initials: LF
authors.lastname: Liu
authors.forename: J Q
authors.initials: JQ
authors.lastname: Zhu
authors.forename: H
authors.initials: H
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000139:chemically induced / Q000209:etiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D018278:Carcinoma, Neuroendocrine / Q000628:therapy*; D018288:Carcinoma, Small Cell / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D048550:Hepatic Insufficiency / Q000139:chemically induced / Q000209:etiology; D006801:Humans; D007044:Hysterectomy; D007069:Ifosfamide / Q000008:administration & dosage; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods*; D009503:Neutropenia / Q000139:chemically induced / Q000209:etiology; D017239:Paclitaxel / Q000008:administration & dosage; D051437:Renal Insufficiency / Q000139:chemically induced / Q000209:etiology; D013921:Thrombocytopenia / Q000139:chemically induced / Q000209:etiology; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000628:therapy*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide