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Locally Advanced Large-Cell Neuroendocrine Carcinoma of the Uterine Cervix: A Case Report

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ESGO State of the Art 2018 Conference

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Abstract

Background: Large-cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is a very aggressive type of tumor even at an early stage. Despite a multimodal treatment approach, a locally advanced stage is often associated with extremely poor prognosis. Case report: A woman, age 45 at diagnosis, was presented clinically with a large 8cm, stage IIIb (FIGO) tumor mass of the cervix. Multiple biopsies patohystologically verified LCNEC. An MRI of the abdomen and pelvis revealed large pelvic mass, dimensions 9x8 cm, (LLxAP) and two liver hemangiomas. The brain CT was normal and at chest CT, several micronodular lesions (with calcifications), by diagnostic parameters, were considered as insignificant, with a recommendation for closely monitoring. Total transcutaneous (TRT) dose of 46 Gy was delivered to the whole pelvis in 25 fractions, concomitant with 5 cycles of weekly cisplatin based chemotherapy (40 mg/m2) and combined with 5 intracavitary brachytherapy applications (central tube and two ovoids, weekly) with a dose of 7 Gy to reference point A/ per application. The tumor showed an excellent response to concomitant definitive chemoradiotherapy (CCRT); the effect was estimated as gross partial regression. Because of initial tumor volume, clinically visible residual Tu (1,5 cm) at the end of CCRT and aggressive tumor nature, by the decision of the tumor board, the patient’s treatment continued every three weeks with systemic Cisplatin-Etoposide-based chemotherapy regiment (CDDP 75 mg/m2, Etoposide 100mg/m2/3 days). After 3 cycles of chemotherapy, there was a clinically minimal rest tumor of the cervix (5 mm) with no evidence of disease progression at chest x-ray and ultrasound of abdomen. The chemotherapy continued up to 6 cycles ending in June 2018. First post-therapy diagnostic evaluation - chest CT scan showed no progression, MRI of the abdomen and pelvis showed no signs of initial disease. Excision biopsy was performed on 5 mm clinically suspicious malignant cervical lesion – microscopic necrotic fragments with inflammatory cells were found, without malignant signs. Now, 13 months after diagnosis, the patient is in excellent condition and with no clinical signs of disease. Further, MRI of the abdomen and pelvis (every 3 months) and chest CT scan annually are scheduled for close follow-up. Conclusion: Definitive concomitant radio-chemotherapy seems to be an effective treatment modality in a locally advanced LCNEC tumor; however, further systemic chemotherapy and close monitoring are necessary due to an aggressive form of the disease.

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