Kevin Yijun Fan

Surgery versus definitive radiotherapy in the management of stage I-II small cell neuroendocrine carcinoma of the cervix: A systematic review and meta-analysis

Small cell neuroendocrine carcinoma of the cervix (SCNECC) is a rare malignancy with poor prognosis. Optimal management of stage I-II disease remains uncertain, with guidelines variably recommending primary surgery or definitive radiotherapy. This study aimed to compare overall survival (OS) in patients with stage I-II SCNECC treated with primary surgery versus definitive radiotherapy through a systematic review and meta-analysis of the current literature. Medline and Embase were searched for English-language studies reporting OS for stage I-II SCNECC treated with either primary surgery or definitive radiotherapy. Studies with ≥5 patients per treatment group were included. Hazard ratios (HR) for OS were pooled using a random-effects meta-analysis. Heterogeneity was assessed with I Of 621 unique records, five studies met the inclusion criteria, encompassing 650 patients treated for stage I-II SCNECC between 1987 and 2012 in 38 hospitals across three countries. Among these patients, 474 underwent primary surgery and 176 received definitive radiotherapy. Of all patients, 84 % received chemotherapy. Median follow-up ranged from 31 to 83 months, and median OS ranged from 21 to 111 months. The pooled HR for OS favoured primary surgery compared to definitive radiotherapy (HR 0.53; 95 % CI 0.31-0.91; p = 0.021). Inter-study heterogeneity was substantial (I In stage I-II SCNECC, primary surgery is associated with longer OS compared to definitive radiotherapy. While findings are limited by the retrospective nature of included studies and potential selection bias, these results support consideration of surgical consultation for eligible patients as part of a multidisciplinary decision-making process. Prospective studies and inter-institutional collaboration are urgently needed to define optimal treatment strategies in this rare malignancy.

Pan-Canadian Analysis of Practice Patterns in Small Cell Carcinoma of the Cervix: Insights from a Multidisciplinary Survey

Small-cell neuroendocrine carcinoma of the cervix (SCNECC) is a rare cancer with poor prognosis, with limited data to guide its treatment. The objective of this study was to evaluate practice patterns in the management of SCNECC. A 23-question online survey on management of SCNECC was disseminated to Canadian gynecologic oncologists (GO), radiation oncologists (RO) and medical oncologists (MO). In total, 34 practitioners from eight provinces responded, including 17 GO, 13 RO and four MO. During staging and diagnosis, 74% of respondents used a trimodality imaging approach, and 85% tested for neuroendocrine markers. In early-stage (1A1-1B2) SCNECC, 87% of practitioners used a surgical-based approach with various adjuvant and neoadjuvant treatments. In locally advanced (1B3-IVA) SCNECC, 53% favored primary chemoradiation, with cisplatin and etoposide, with the remainder using surgical or radiation-based approaches. In metastatic and recurrent SCNECC, the most common first-line regimen was etoposide and platinum, and 63% of practitioners considered clinical trials in the first line setting or beyond. This survey highlights diverse practice patterns in the treatment of SCNECC. Interdisciplinary input is crucial to individualizing multimodality treatment, and there is a need for prospective trials and intergroup collaboration to define the optimal approach towards managing this rare cancer type.