J. S. Fernandes1, A. Hodgson2, K. Han1, M. Milosevic3, J. Lukovic4, S. Lheureux5, S. E. Ferguson6, A. T. Santiago7, and J. M. Croke8; 1Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 2Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada, 3Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada, 4Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada, 5Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 6Department of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada, 7Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 8Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
Purpose/Objective(s): Neuroendocrine cervical cancers are a rare but aggressive malignancy associated with a poor prognosis and limited evidence to guide clinical decision-making. Our objective was to evaluate the patterns of practice and clinical outcomes of patients diagnosed with neuroendocrine cervical cancer at a large academic cancer center. Materials/
Methods: This was a retrospective chart review of patients between January 2007 and December 2023 with biopsy positive neuroendocrine cervical cancer. Demographic, treatment, and clinical outcome data were extracted from the medical records and summarized using descriptive statistics. Overall survival (OS) was analyzed using the Kaplan-Meier method and was compared between those receiving primary surgery and primary radiotherapy using the Log-rank test. The Wilcoxon rank-sum test and Fisher’s exact test were used to evaluate patient factors associated with primary treatment. Results: In total, 32 patients were diagnosed with primary cervical neuroendocrine carcinoma between 2007 and 2023 and were included in our analysis. Median follow-up was 14.5 months, and median age at diagnosis was 52 (range 21-89), most (31.3%, 10/32) were stage IVB at time of diagnosis and 15.6% (5/32) were node-positive without evidence of distant metastases. Primary treatment consisted of surgery in 10 patients (31.3%) and chemo-radiation in 15 patients (46.9%), with the remainder of patients (7/32, 21.9%) unfit for radical therapy. The overall stages of those treated with primary surgery were 1A2-2A1, whereas primary chemo-radiotherapy was offered to patients from stages IB1-IVB. Among patients treated with primary surgery, 70% (7/10) received adjuvant concurrent chemo-radiotherapy followed by adjuvant chemotherapy. Of those treated with primary radiotherapy, 100% received concurrent cisplatin chemotherapy, 73.3% (11/15) received brachytherapy and 86.7% (13/15) received adjuvant chemotherapy. Adjuvant chemotherapy was a combination of cisplatin and etoposide, except in cases where either of the drugs may have been contraindicated. Median OS for the full cohort was 19 months (2-year OS 39%). Patients treated with primary surgery had significantly higher median OS compared to those treated with primary radiotherapy (39 vs 19 months, p=0.04). Patients treated with primary radiotherapy had significantly larger tumor size on diagnostic MRI compared to those treated with primary surgery (4.3cm vs. 1.8cm; p=0.029). No other patient factors were significantly different between the surgery and radiotherapy groups, including stage; however, this is likely due to the limited sample size. Conclusion: In our single institution review of neuroendocrine cancer of the cervix, primary surgery was associated with improved OS, however our sample size was quite limited highlighting the rarity of this malignancy and the importance of prospective, multi-institutional studies. Comprehensive molecular profiling is underway to help guide systemic therapy.
