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

O&#39;Shea, J; Yu, K; Chang, D; Khaw, P; Mileshkin, L; McNally, O; Narayan, K; Kondalsamy-Chennakesavan, S; Lin, MY

Author(s): O'Shea, J; Yu, K; Chang, D; Khaw, P; Mileshkin, L; McNally, O; Narayan, K; Kondalsamy-Chennakesavan, S; Lin, MY;
Details: Publication Year 2026-02,Volume 36,Issue #2,Page 102874
Journal Title: International Journal of Gynecological Cancer
Publication Type: Research article
Abstract: OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Keywords: Cervix Uteri; Chemoradiotherapy; Nodal Metastases; Patterns of Failure; Platinum-Etoposide; Radiotherapy; Small Cell Neuroendocrine Carcinoma; Survival
Department(s): Radiation Oncology; Medical Oncology
Publisher's Version: https://doi.org/10.1016/j.ijgc.2025.102874
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-01-23 11:58:23

Last Modified: 2026-01-23 12:00:54