Small cell neuroendocrine carcinoma of the cervix: insights from a state cancer institute in India.

Abstract

Background: Small-cell neuroendocrine carcinoma of the cervix (NECC) is a rare and aggressive malignancy, accounting for 0.5%-1% of invasive cervical cancers. It is marked by rapid progression, early nodal and distant spread, and poor survival even in early stages. Management is challenging in low- and middle-income countries (LMIC) due to delayed diagnosis and advanced presentation. This study describes the clinicopathological features, treatment approaches and outcomes from a state cancer institute in India.

Methods: We retrospectively analysed data of women with biopsy-proven NECC treated between January 2004 and December 2020 at a tertiary state cancer centre. Clinical, pathological and treatment data were extracted. Immunohistochemistry confirmed all cases. Survival was assessed using Kaplan-Meier analysis.

Results: Of 54 patients identified, 32 were included for analysis. Median age was 51.2 years (range 30-77). Most patients were multiparous, 87.5% illiterate and 31.2% tobacco users. Advanced disease presentation noted, 68.7% with stage III and 12.5% with stage IV. Tumour size >4 cm was noted in 81.2%, pelvic nodes in 53.1% and para-aortic nodes in 29%. Treatment included concurrent chemoradiation (n = 19), surgery and adjuvant chemoradiation (n = 5), neoadjuvant chemotherapy followed by chemoradiation (n = 5) and palliative therapy (n = 3). Platinum-etoposide was the most frequently used chemotherapy regimen. Median time to recurrence was 9 months; pelvic and distant metastases were common. Four-year overall survival was 24.7%. Only two long-term survivors were observed, both stage III patients treated with intensive multimodality therapy.

Conclusion: NECC demonstrates aggressive clinical behaviour with poor survival despite multimodality treatment. Early diagnosis, timely systemic therapy and collaborative multicentre data are essential to improve outcomes, especially in LMIC settings.