Small cell carcinoma of the cervix

32 year old woman with small cell carcinoma of the cervix.  Tumor limited to ovary and side wall and totally resected.  patient received BEP x 4, then EP x 2 finishing three months ago.  Now have recurrent disease in pelvis.  Recommendations?

Mike Birrer

Response # 1:  
Dear Mike,
Unfortunately, this patient shows a rather typical course of this extremely aggressive tumor. We had a case series publishes on behalf of GCIG some years ago. We found some hints for a beneficial impact of radiotherapy. So to say, if the disease is still loco-regional radiotherapy +/- surgery could be an option. However, the prognosis of this patient is very poor and counseling about palliative care and preparation of deceasing in the near future (its probably more months than years) might not be neglected.
Best Wishes
Andreas du Bois
Response # 2:  
If patient has not received consolidation radiation therapy I would recommend pelvic XRT.

Subir Nag

Response # 3:  
In my data, there was no significant difference in OS between adjuvant CTx and CRT as adjuvant therapy in SCNEC.

But, this is recurrent disease.

So, I will consider treatment option as follows,

1. really pelvic disease?

2. if true, CTx for 3-6 cycles (personally favor 3) including paclitaxel and CBDCA

3. then, if respond and no extrapelvic dz, CRT followed by extended CTx

3-1. if extrapelvic disease, palliative tx.

4. surgical resection such as exenteration or LEER would not be adequate tx option because of SCNEC

Would you let me know your treatment plan and result?

Jong Min Lee

Response # 4:  
Hi Mike,

Assume she had surgery first time round and chemo was adjuvant- if no disease else where and only microscopic pelvis disease then I would give pelvic RT +/- concomitant cisplatin and aim to get local control.

Mary McCormack

Response # 5:  
If staging shows no disease elsewhere I would consider either concomitant chemo radiation or  perhaps 4-6 cycles  of carbo/paclitaxel followed  by pelvic EBRT and  vag brachy
i assume  you will be doing PET CT and  or MR
If distant mets, she  is stuffed  but would go for carbo -paclitaxel either standard q 3 weeks  or  even weekly dose dense
Good luck
Nick Reed
Response # 6:  

I have an experience of a patient with small cell carcinoma of the cervix who underwent neoadjuvant chemotherapy with docetaxel plus carboplatin as a phase II clinical trial.

She had almost pathological complete response.

Keiichi Fujiwara

Response # 7:  
Dear Mike
We think the best option for her if PET neg outside of the pelvis would be rads (whole abdo plus a boost) followed by carbo taxol x4....not much to support this I know and given the chemoresistance....

Michael Quinn

Response # 8  
Concomitant radiochemotherapy or if the diameter is < 5 cm and no distant MTS Surgery.

This choice is questionable looking at the histology.

Paolo Zola

Response # 9  
Dear Dr Small

I have been forwarded this.

There is not a lot of evidence regarding what to do in this situation.

Has she had a PETCT? If not do you have access?

Is she postop TAH, BSO and PLND?

If so I would try and deliver 45Gy in 25# with weekly Cisplatin to whole pelvis and then boost the areas of bulk a further 5.4Gy. If she has in situ disease then I might boost the involved nodes to TD 54Gy. The role of BT is controversial, we haven’t tended to do this as most are post op and the dose for lung has been around this dose level.

Then she needs to continue ‘adj’ chemotherapy with Cisplatin VP-16.

This is not based on much evidence, but it is awhile since I last looked. The few cases I have treated this way have done ok.

 I hope that this is useful

Regards Scott Babington