Cervix­carcinoom

Neuro-endocrien carcinoom (NEC) van de cervix

• 1. Beperkte ziekte (FIGO 2018 stadium IA t/m IB2 + IIA1)

  Beperkte ziekte:

  • Primaire behandeling is chirurgie (Radicale hysterectomie en pelviene lymklierdissectie),
  • Adjuvante chemotherapie;
    • Etoposide (100 mg/m2 dag 1,2,3) en cisplatin (80 mg/m2), cyclusduur 21 dagen, 4 cycli.  

• 2. Uitgebreide ziekte (FIGO 2018 stadium IB3 + IIA1 t/m IVA)

  Uitgebreide ziekte:

  • Neoadjuvante chemotherapie:
    • Etoposide (100 mg/m2 dag 1,2,3) en cisplatin (80 mg/m2), cyclusduur 21 dagen, 4 cycli.

  • Bij partiele response: dan overwegen 6 cycli.
  • Chemoradiatie:
    • Uitwendige radiotherapie van het bekken tot 45Gy in 25 fracties van 1,8Gy, gecombineerd met wekelijks cisplatin,
    • Brachytherapie van de primaire tumor tot een cumulatieve equivalente dosis van 80-85 Gy. Dit zal normaliter in 3 fracties kunnen.

Literatuur

1. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999 Apr 15;340(15):1137-43.
2. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999 Apr 15;340(15):1144-53. Erratum in: N Engl J Med 1999 Aug 26;341(9):708.
3. Green JA et al. Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix (review). Cochrane Database Syst Rev 2005;20(3):CD002225.
4. K. Katanyoo, S. Tangjitgamol, M. Chongthanakorn, T. Tantivatana, S. Manusirivithaya, K. Rongsriyam, Treatment outcomes of concurrent weekly carboplatin with radiation therapy in locally advanced cervical cancer patients. Gynecologic Oncology 2011:123;571–576.
5. P. Zusterzeel, Aarts, Ottevanger et al. Neoadjuvant Chemotherapy Followed by Vaginal Radical Trachelectomy as Fertility‐Preserving Treatment for Patients with FIGO 2018 Stage 1B2 Cervical Cancer The Oncologist 2020;25:1–9.
6. Peters WA et al. Concurrent Chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early stage cancer of the cervix. J Clin Oncol 2000;18:1606-1613.
7. Rosa DD et al. Adjuvant platinum-based chemotherapy for early stage cervical cancer. Cochrane Database of Syst Rev 2009;3(3):CD005342.
8. Monk BJ et al. Rethinking the use of radiation and chemotherapy after radical hysterectomy: a clinical- pathologic analysis of a Gynaecologic Oncology Group / Southwest Oncology Group / Radiation Therapy Oncology Group Trial. Gynaecol Oncology 2005;96:721-728.
9. Tewari KS et al. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med 2014;370:734-743.
   1. a: Colombo N, Dubot C, Lorusso D, et al; KEYNOTE826 Investigators. Pembrolizumab for persistent, recurrent, or metastatic cervical cancer. N Engl J Med 2021;385(20):185667.
10. Kitagawa R et al. Paclitaxel plus carboplatin versus paclitaxel plus cisplatin in metastatic or recurrent cervical cancer: the open-label randomized phase III trial JCOG0505. J Clin Oncol 2015;33:2129-2135.
11. Long HJ, Bundy BN, Grendys EC, et al., Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: A gynecologic Oncology group study. J Clin Oncol 2005 July 20 23 (21) 4626-4633.
12. Sofie Torfs, Isabelle Cadron. Evaluation of paclitaxel/carboplatin in a dose dense or weekly regimen in 66 patients with recurrent or primary metastatic cervical cancer. European Journal of Cancer 48 (2012).
13. Jaime Coronel¹, Lucely Cetina¹, Myrna Candelaria¹, Weekly topotecan as second- or third-line treatment in patients with recurrent or metastatic cervical cancer Medical Oncology volume 26, pages210–214(2009).
14. Salvo G, et al. Updates and management algorithm for neuroendocrine tumors of the uterine cervix. Int J Gynecol Cancer 2019;29:986–995.