Clear Cell Carcinoma of the Cervix

Question:
Dear friends,

16yo. presented with PCB,mass on cervix, consistent with 1B1 (3cm lesion biopsy proven extent of lesion). Biopsy confirms clear cell CA. PET/MRI shows disease confined to cervix.

Neoadjuvant chemo given, carbo/taxol, good 2 cycles response, downsized, then TLRH, conservation of ovaries.

Final path of hyst specimen, shows margins well clear, all nodes -ve. No LVSI. Note final tumor 9mm on path. See all other attached info.

We are grappling with whether to give her any adjuvant. Half of us want to offer her 2 more cycles chemo, whereas some of us feel she is adequately treated. No strong consensus on XRT, as the whole point was to avoid that....

Thanks,

Michael Quinn


 
 
Response # 1:  
My thoughts – no radiation therapy – but I would give her 2 more courses of chemotherapy since there was still residual disease left in the specimen

Anuja Jhingran
 

 
Response # 2:  
I would probably give her more chemo either 2 or 3 cycles carbo-pac.
Alternative is single agent cisplatin 4-6 cycles of 50 mg/ms.
I would also think about vag colpostats? Did you do oophoropexy??

Tricky but is saving fertility better than saving life?

Nick
Dr. Nicholas Reed
 

 
Response # 3:  
Dear Michael,

Great job.

I will definitely give additional chemotherapy. Our policy on neoadjuvant chemotherapy and adjuvant chemotherapy is 6 cycles in total.

Sincerely yours,

Keiichi
Keiichi Fujiwara
 

 
Response # 4:  
Hi Michael,

Certainly interesting case. We would probably not give her any adjuvant treatment at this stage. There was no sign of metastasis beforehand and not afterwards, additionally, there is no evidence that more than 2 cycles does better with regard to distant metastasis.

Regards,

Ruud
Dr. Ruud L.M. Bekkers
 

 
Response # 5:  
Hi Michael,

Two courses of chemo has downsized her tumour and indicated that is responsive to taxol/carbo but would not be optimal for adjuvant therapy of a high-risk histology such as clear cell.

Therefore I would suggest continuing with 2-4 more cycles.

I agree that RT should be avoided.

Best,

Tony
Anthony Fyles
 

 
Response # 6:  
Dear All,

Based on definitive pathology, we wouldn't give her any further treatment. Strict follow-up.

Best Wishes,

Stefano
Stefano Greggi, MD, PhD
 

 
Response # 7:  
Dear Michael,

I would consider her to be adequately treated i.e NFT.

Best regards,

Elisabeth
Elisabeth Åvall Lundqvist, M.D, Ph.D, Professor
 

 
Response # 8:  
Very bad case!!!

We suggest 2 more cycles of chemo.

Mauro Signorelli, MD
 

 
Response # 9:  
I usually gives 3 courses of chemo when I give neoadjuvant chemo to cervical cancer.

I would rather consider 4 than 2 courses, but do not have strong data.

Best regards,

Gunnar Kristensen
 

 
Response # 10:  
This tumor is not common, and neoadjuvant treatment is a very good option but consolidation chemo should be considered as a good option in a case like this, especially when a good response has been achieved.

It will be great to hear the final consensus on the treatment of this particular patient.

David Cantú, MD
 

 
Response # 11:  
No further treatment.

Kailash Narayan
 

 
Response # 12:  
Michael,

I would not add any adjuvant chemotherapy, the neoadjuvant would be the upback and therefore no outback.

Ben Greer
 

 
Response # 13:  
Hi Michael,

Tough case in a 16yr old. My preference would be to give chemo-rads as adjuvant.

A.
Amit M. Oza
 

 
Response # 14:  
Dear Michael,

My own feeling would be to offer her 2 cycles more of chemo as she is a good responder and try to avoid XRT, rather than proposing a more standard approach with XRT. Arguments: she was not initially treated according to standard due to the atypycal histological type and young age. There is no reason to vary from initial attitude as the strategy seems a winning one. Neo-adjuvant chemo has not the only goal to decrease the size of the tumor but also to remove micrometastasis. In this last respect, 2 cycles without XRT appears too minimal.

Kind regards,

Eric
Eric Pujade-Lauraine