Primary surgery versus primary radiation therapy for FIGO stages I–II small cell carcinoma of the uterine cervix: A retrospective Taiwanese Gynecologic Oncology Group study

• We conduct a nationwide retrospective study in small cell cervical cancer (SCCC).
• SCCC with tumor ≤ 2 cm and no LVSI can be treated with surgery and chemotherapy.
• For most SCCC, radiotherapy with aggressive chemotherapy links to better survival.

Objective: To evaluate the role of surgery, radiation therapy and chemotherapy in the management of small cell carcinoma of the uterine cervix (SCCC) through a retrospective study of Taiwanese Gynecologic Oncology Group.Methods: We reviewed the medical records and histological files of 144 patients with FIGO stages IA–IIB SCCC treated in 11 main hospitals in Taiwan from 1987 to 2009.Results: There were 110 patients receiving primary surgery and 34 primary radiation therapy. Most patients in each group also received chemotherapy as part of primary treatment. A lower loco-regional failure rate was observed in patients who received primary radiation therapy than in those who had primary surgery (6% vs. 27%; P = 0.009). The 5-year overall survival (OS) was 89% for 13 surgically treated patients with cervical tumor ≤ 2 cm and no lymphovascular space involvement (LVSI) in whom recurrence was noted in 2 of 4 patients without receiving adjuvant chemotherapy and none in the 9 patients who had chemotherapy. Excluding these 13 patients, primary radiation therapy with at least 5 cycles of platinum-based chemotherapy (n = 14, including 12 stages IB2–IIB) resulted in a 5-year OS of 78%, better than that of 46% by primary surgery (n = 97, including 40 stages IB2–IIB) (P = 0.046).Conclusions: None of the 9 patients with cervical tumor ≤ 2 cm and no LVSI showed disease recurrence after primary surgery and adjuvant chemotherapy. For most patients with stages I–II, primary radiation therapy with aggressive chemotherapy was associated with better survival than surgery.