Gynecological Cancer

SS 24 - GYN 1

174 - Small Cell Carcinoma of the Cervix: Definitive Chemoradiation for Locally Advanced Disease

Tuesday, October 23
2:20 PM - 2:30 PM
Location: Room 007 A/B

Small Cell Carcinoma of the Cervix: Definitive Chemoradiation for Locally Advanced Disease
A. Bajaj1, M. Frumovitz2, B. Martin3, A. Jhingran4, K. V. Albuquerque5, A. Yen5, E. L. Jones6, D. K. K. Gaffney7, M. C. Christensen7, D. N. Ayala-Peacock8, D. M. Wharton8, S. Jolly9, P. Kale10, K. Ryan1, K. Nieto11, M. M. Harkenrider1, and W. Small Jr1; 1Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 2Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 3Clinical Research Office, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 4Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 5University of Texas Southwestern Medical Center, Dallas, TX, 6University of North Carolina Hospitals, Chapel Hill, NC, 7Department of Radiation Oncology, Hunstman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, 8Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, 9Michigan Medicine, Ann Arbor, MI, 10Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 11Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL

Purpose/Objective(s): Small cell carcinoma of the cervix (SCCC) is a rare neuroendocrine malignancy with no established treatment guidelines informing management. There is limited existing data on patients with locally advanced SCCC treated with definitive chemoradiation (CRT). The present multi-institutional study aimed to assess outcomes of patients treated at seven academic centers in the U.S.

Materials/Methods: Patients with FIGO IB2-IVA SCCC treated with definitive CRT were retrospectively reviewed for sociodemographic, clinical, treatment response, and survival data. Time to recurrence (TTR) was defined as time from first treatment to recurrence. Univariable frailty models examined TTR and time to brain recurrence; multivariable frailty models controlling for FIGO stage and node positivity assessed overall survival (OS) and analyzed interaction effects of chemotherapy agents and number of cycles on OS and recurrence.

Results: 73 patients met inclusion criteria; 41 patients (56.1%) were stage IB2-IIB, 20 patients (27.4%) were stage III, and 10 patients (13.7%) were stage IV. Mean age at diagnosis was 44 (SD: 14.5). 8 patients (16.3%) were HPV positive. 40 patients (58.8%) had pelvic/para-aortic (PA) node disease. 35 patients (52.2%) were treated with cisplatin vs. 28 patients (41.8%) treated with cisplatin and etoposide. 54 patients (74.0%) had brachytherapy (BT). The median follow-up time was 18.7 mo. (IQR: 13.3-47.4). 66.2% of patients recurred; median TTR was 10.4 mo. (95% CI: 7.8-16.5). Recurrence was associated with current smoking (HR: 3.32, p<.01), pelvic/PA node disease (HR: 2.84, p=.01), EQD2 <50 Gy vs. 71-80 Gy (HR: 3.3, p=.07), HPV negativity (HR: 2.4, p=.16) and no BT (HR: 1.5, p=.25). 15.1% of patients recurred in the brain; decreased hazard of brain recurrence was associated with BT (HR: .05, p<.01), EQD2 >75 Gy (HR: .11, p=.04), and receipt of cisplatin and etoposide vs. cisplatin only (HR: .35, p=.23). OS for all patients was 47.9%; factors associated with OS trending toward significance were HPV positivity (HR: .18, p=.10), EQD2 >50 Gy (p=.10), and chemotherapy timing (p=.02), favoring concurrent and adjuvant chemotherapy vs. concurrent only (HR: .49, p=.10). The interaction of cisplatin and etoposide with number of cycles was associated with OS (HR: 0.45, p=.01) and decreased recurrence (HR: .67, p=.07); this effect was not found for cisplatin only (HR: 1.05, p=.59 and HR: 1.04, p=.65, respectively). Patients receiving cisplatin and etoposide demonstrated improved OS (59.3% vs. 44.1%) and a lower recurrence rate (65.2% vs. 73.5%) compared to those receiving cisplatin only.

Conclusion: The present study is the largest study to date specifically analyzing locally advanced SCCC treated with definitive CRT. Patients demonstrated improved outcomes when treated with concurrent and adjuvant chemotherapy, especially with cisplatin and etoposide, EQD2 >75 Gy, and BT. The investigators await longer follow-up and a larger study population to further explore locally advanced SCCC.

Author Disclosure: A. Bajaj: None. M. Frumovitz: Advisory Board; Ethicon, Novadaq. B. Martin: None. A. Jhingran: Written Examinations Co-Chair GYN Committee; American Board of Radiology. K.V. Albuquerque: Research Grant; Pfizer. Honoraria; ACR. Travel Expenses; ACR, AART, ABR. CHAIR GYN TRACK; ASTRO SCIENTIFIC COMMITTEE. A. Yen: None. E.L. Jones: Member; NCI GI Steering Committee. D.K. Gaffney: Consultant; NCI. Co-chair; NCI. M.C. Christensen: None. D.N. Ayala-Peacock: Employee; Anesthesia Medical Group. NRG Cervix General Committee Member; NRG. D.M. Wharton: None. P. Kale: None. M.M. Harkenrider: Radiation oncology program director and Trustee; Chicago Radiological Society. W. Small: Research Grant; Zeiss. Honoraria; Zeiss. Travel Expenses; Zeiss. Co-Chai Gyn Working Group; RTOG. Chair; GCIG. Co-Chair Gynecology Committee; NRG Oncology. CSC Member; ACR.

Amishi Bajaj, MD

Disclosure:
No relationships to disclose.

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