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- W2897870145 abstract "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. 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. A total of 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. 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." @default.
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- W2897870145 date "2018-11-01" @default.
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- W2897870145 title "Small Cell Carcinoma of the Cervix: Definitive Chemoradiation for Locally Advanced Disease" @default.
- W2897870145 doi "https://doi.org/10.1016/j.ijrobp.2018.06.226" @default.
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