Background/Aim: Although still controversial, the current treatment for locally advanced neuroendocrine carcinoma of the cervix (NECC) relies on chemoradiation (CRT). The aim of this study is to evaluate the alternative role of combined chemotherapy and surgery in treating NECC. Patients and Methods: This is a retrospective series of patients undergoing radical surgery after neoadjuvant chemotherapy (NACT) for locally advanced NECC (stages IIB-IVA). Histological examination and immunohistochemistry were performed on surgical specimens to confirm diagnosis. Systematic literature search was conducted to identify other cases treated with chemotherapy and surgery. Results: Seven patients with a mean age of 49 years were identified. The mean greatest diameter at diagnosis was 59.3±24.7 mm. FIGO stage was IIB in 14.3% of patients, IIIB in 28.6%, IIIC in 42.9%, and IVA in 14.3%. The response to NACT was partial, ranging from 50% to 80%. Neuroendocrine markers were expressed in all cases. The mean progression-free survival (PFS) and overall survival (OS) were 15.0±30.6 months and 26.3±36.4 months, respectively. Eleven studies encompassing a total of 27 patients met eligibility criteria for the systematic review. Conclusion: Surgery after NACT for locally advanced NECC may yield similar outcomes compared to CRT. The benefit of performing surgery as a primary approach could lie in the possibility of reserving CRT for recurrences. Since randomized clinical trials are difficult to be designed, an expert consensus is required to address the non-inferiority of radical surgery over CRT.

Radical surgery after neoadjuvant chemotherapy for locally advanced neuroendocrine cancer of the cervix / Caruso, Giuseppe; Palaia, Innocenza; DI DONATO, Violante; Pernazza, Angelina; Gallo, Roberta; Perniola, Giorgia; Leopizzi, Martina; DELLA ROCCA, Carlo; Muzii, Ludovico; Panici, PIERLUIGI BENEDETTI. - In: ANTICANCER RESEARCH. - ISSN 0250-7005. - 41:9(2021), pp. 4431-4438. [10.21873/anticanres.15250]

Radical surgery after neoadjuvant chemotherapy for locally advanced neuroendocrine cancer of the cervix

CARUSO, GIUSEPPE
;
PALAIA, INNOCENZA;DI DONATO, VIOLANTE;PERNAZZA, ANGELINA;GALLO, ROBERTA;PERNIOLA, GIORGIA;LEOPIZZI, MARTINA;DELLA ROCCA, CARLO;MUZII, LUDOVICO;PANICI, PIERLUIGI BENEDETTI
2021

Abstract

Background/Aim: Although still controversial, the current treatment for locally advanced neuroendocrine carcinoma of the cervix (NECC) relies on chemoradiation (CRT). The aim of this study is to evaluate the alternative role of combined chemotherapy and surgery in treating NECC. Patients and Methods: This is a retrospective series of patients undergoing radical surgery after neoadjuvant chemotherapy (NACT) for locally advanced NECC (stages IIB-IVA). Histological examination and immunohistochemistry were performed on surgical specimens to confirm diagnosis. Systematic literature search was conducted to identify other cases treated with chemotherapy and surgery. Results: Seven patients with a mean age of 49 years were identified. The mean greatest diameter at diagnosis was 59.3±24.7 mm. FIGO stage was IIB in 14.3% of patients, IIIB in 28.6%, IIIC in 42.9%, and IVA in 14.3%. The response to NACT was partial, ranging from 50% to 80%. Neuroendocrine markers were expressed in all cases. The mean progression-free survival (PFS) and overall survival (OS) were 15.0±30.6 months and 26.3±36.4 months, respectively. Eleven studies encompassing a total of 27 patients met eligibility criteria for the systematic review. Conclusion: Surgery after NACT for locally advanced NECC may yield similar outcomes compared to CRT. The benefit of performing surgery as a primary approach could lie in the possibility of reserving CRT for recurrences. Since randomized clinical trials are difficult to be designed, an expert consensus is required to address the non-inferiority of radical surgery over CRT.
2021
locally advanced cervical cancer; neuroendocrine carcinoma; radical surgery; chemoradiation
01 Pubblicazione su rivista::01a Articolo in rivista
Radical surgery after neoadjuvant chemotherapy for locally advanced neuroendocrine cancer of the cervix / Caruso, Giuseppe; Palaia, Innocenza; DI DONATO, Violante; Pernazza, Angelina; Gallo, Roberta; Perniola, Giorgia; Leopizzi, Martina; DELLA ROCCA, Carlo; Muzii, Ludovico; Panici, PIERLUIGI BENEDETTI. - In: ANTICANCER RESEARCH. - ISSN 0250-7005. - 41:9(2021), pp. 4431-4438. [10.21873/anticanres.15250]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1590275
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