The Importance of Choosing the Right Strategy to Treat Small Cell Carcinoma of the Cervix: A Comparative Analysis of Treatments

Abstract Background: Standard treatments for small cell carcinoma of the cervix (SCCC) is unclear. We aimed to estimate the optimal treatment strategy for SCCC. Methods: This was a multicentre retrospective study. Medical records of patients with pathologically proven SCCC treated between 2003 and 2016 were retrospectively analyzed. Overall survival (OS) was plotted using the Kaplan-Meier method. The log-rank test and cox regression model were used to assess the differences in survival due to the stage, treatment strategy, and chemotherapy regimen. Results: Seventy-seven patients were evaluated. Their median age was 47 (range: 24-83) years. The number of patients with stage I, II, III, and IV, as defined according to the Union for International Cancer Control (UICC), was 28, 9, 24, and 16, respectively. Of 64 patients who had undergone chemotherapy, 43 received a small cell carcinoma regimen and 21 received a non-small cell carcinoma regimen as their first-line chemotherapy regimen. The 5-year OS for all patients was 51%. The 5-year OS rates for the patients with UICC stage I, II, III, and IV were 61%, 76%, 54%, and 18%, respectively. The 5-year OS rates for patients who underwent treatments with a small cell carcinoma and non-small cell carcinoma regimen were 62% and 15% (p<0.001), respectively. This trend was observed in all UICC stages, except in stage I. Multivariate analysis showed that presence of metastasis was a significant prognostic factor in all the patients. Application of surgery was not a significant prognostic factor in multivariate analysis. The 5-year OS was similar in the concurrent chemoradiotherapy (CCRT) and surgery group if CCRT with small cell carcinoma regimen was selected. Conclusion: The role of chemotherapy in stage I SCCC is unclear; however, if chemotherapy is applicable, SCCC patients should be treated with a chemotherapy regimen used for localized small cell carcinoma.