Pearly Khaw

Survival and patterns of failure in small cell neuroendocrine carcinoma of the cervix treated with definitive chemoradiotherapy

To evaluate survival outcomes and patterns of failure in small cell neuroendocrine carcinoma of the cervix treated with curative-intent chemoradiotherapy at a tertiary referral center. Patients with International Federation of Gynecology and Obstetrics 2009 stage IB to IIIB small cell neuroendocrine carcinoma of the cervix treated between 1996 and 2017 were retrospectively reviewed. All underwent baseline magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT). Definitive chemoradiotherapy consisted of pelvic external-beam radiotherapy (45 Gy/25 fractions) with high-dose-rate brachytherapy (Equivalent Dose in 2Gy fractions (EQD2) >85 Gy) and concurrent platinum-etoposide chemotherapy, followed by 2 sequential cycles. Patients who underwent primary surgery followed by adjuvant chemoradiotherapy were analyzed separately. Survival outcomes were estimated using Kaplan-Meier analysis. Thirty-two patients were included; 26 received definitive chemoradiotherapy and 6 underwent surgery followed by adjuvant radiotherapy. Median follow-up was 48 months (interquartile range; 12-213). Five-year overall survival and progression-free survival were 54.6% and 49.7%, respectively. Pelvic control was high (88%), with no local relapses in patients with stage ≤IIA disease. Distant relapse occurred in 44% of patients, predominantly para-aortic (57%) and visceral (lung, liver, bone). Node-negative patients achieved significantly higher 5-year overall survival (70.6% vs 31.3%, p = .04) and progression-free survival (66.9% vs 22.4%, p = .01). Definitive chemoradiotherapy achieves excellent loco-regional control and durable survival in small cell neuroendocrine carcinoma of the cervix, particularly in early-stage and node-negative disease. Distant relapse remains the predominant failure pattern, highlighting the need for improved systemic approaches. These results support omission of radical surgery in well-staged early-stage patients managed with modern chemoradiotherapy.

Node-positive carcinoma of the vulva treated with curative-intent radiotherapy

This study aimed to evaluate the outcomes of patients with node-positive vulvar carcinoma treated with radiotherapy, with or without chemotherapy, administered with curative intent, focusing on patterns of first failure, locoregional control, and overall survival. Patients were eligible if they had a histologic diagnosis of node-positive vulvar cancer and were referred for curative-intent radiotherapy, with or without chemotherapy, either as the primary treatment or in the adjuvant setting following definitive surgery between January 2000 and December 2019 at our institution. Eligible patients were selected from the prospective database of the gynecology oncology unit, where clinical, histopathologic, treatment, and follow-up data were systematically collected for analysis. Out of 256 patients with vulvar cancer, 88 (34.4%) patients met the inclusion criteria. The median age was 65 years (range; 33-90). Sixty-two patients underwent surgery and adjuvant radiotherapy, of whom 57 (92%) received concomitant chemotherapy. Twenty-four patients received definitive chemoradiotherapy and 2 received definitive radiotherapy alone. The median total dose to the primary site was 54 Gy in the definitive setting and 45 Gy in the adjuvant setting. The median dose was 54 Gy (range; 45-60) to gross inguinal nodes (n = 48) and 54 Gy (range; 34-64) to gross primary disease (n = 26). The median follow-up was 5.3 years (range; 0.1-21.8). Five-year overall survival was 62% in the adjuvant group and 50% in the definitive group. Of 88 patients, 46 (52%) relapsed; 16 of 46 (35%) had failure at the primary site alone. Disease control at the primary site and nodes was 64% (95% CI; 48%-75%) in the adjuvant group and 49% (26%-68%) in the definitive group at 5 years. Locoregional control and overall survival were highest in patients treated with surgery followed by radiotherapy. Definitive chemoradiotherapy provided moderate disease control and survival outcomes in patients unfit for surgery, supporting its use as an alternative treatment strategy.