title: Brachytherapy should not be omitted when treating locally advanced neuroendocrine cervical cancer with definitive chemoradiation therapy.
abstract: Neuroendocrine cervical cancer is a rare malignancy with a poor prognosis, yet there is a paucity of data to guide treatment decisions when managing patients with this diagnosis. Specifically, there are little data to aid practitioners in deciding if there is added value to brachytherapy given the additional time, cost, discomfort, and toxicity to patients.
  
  
  
  We used the National Cancer Data Base to identify women with locally advanced neuroendocrine cervical cancer treated with definitive chemoradiotherapy to determine if the addition of brachytherapy improves outcomes in this disease. We also assessed outcomes based on chemotherapy timing in this cohort.
  
  
  
  We identified 100 patients with locally advanced nonmetastatic neuroendocrine cervical cancer that were treated with definitive chemoradiotherapy between 2004 and 2012. There was a substantial improvement in overall survival when brachytherapy was administered in addition to external beam radiotherapy. In multivariate analysis, the addition of brachytherapy, compared with external beam radiotherapy alone, was associated with an improved median survival of 48.6 vs. 21.6 months (hazard ratio (HR), 0.475; 95% CI, 0.255-0.883; p = 0.019). We observed no difference in overall survival for patients treated with neoadjuvant chemotherapy compared with the group who received chemotherapy started concurrently with radiation (HR, 0.851; 95% CI, 0.483-1.500; p = 0.578).
  
  
  
  Brachytherapy should be considered an essential component of definitive chemoradiotherapy for the treatment of neuroendocrine cervical cancer. Chemotherapy timing, however, does not impact outcome.
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO.
authors.forename: Tyler P
authors.initials: TP
authors.lastname: Robin
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO.
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Schefter
authors.affiliation: Department of Gynecologic Oncology, University of Colorado Cancer Center, Aurora, CO.
authors.forename: Kian
authors.initials: K
authors.lastname: Behbakht
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO. Electronic address: christine.fisher@ucdenver.edu.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D018278:Carcinoma, Neuroendocrine / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D016208:Databases, Factual; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: Brachytherapy; Cervical cancer; Large cell neuroendocrine; Radiation; Small cell neuroendocrine