Treatment and outcomes of small cell neuroendocrine carcinoma of the cervix (SCCC).

5531 Background: Extrapulmonary small cell carcinoma is rare. SCCC represent 2% of cervical cancers and can portend a poor prognosis. Treatment standardization is challenging given its rarity. We describe management of limited stage (LS; disease could be encompassed within one radiation port) at a large tertiary referral center and the characteristics and outcomes in a cohort of patients (pts) with LS and extensive stage (ES) SCCC. Methods: Pts with SCCC diagnosed from 1/1990-1/2016 were identified following IRB approval. Clinicopathologic, treatment, and follow-up data were recorded. Descriptive statistics were provided. Median PFS/OS or PFS/OS rate were estimated using Kaplan-Meier method. Results: 39 pts were identified, 29 with LS. Select characteristics are shown in table. Tumor molecular profiling revealed MYC amplifications, TP53 mutations, PIK3CA mutation among the small subset of pts who had this performed. LS SCCC was treated with whole pelvic radiation therapy (RT) (4500-5040cGy) and concurrent IV cisplatin (60mg/m2) on day 1 and etoposide (120mg/m2) on days 1, 3, and 5 during RT and days 1-3 post RT to complete a total of 4 cycles. 26 pts, all had LS, underwent initial surgical management. No pt had prophylactic cranial RT. 3 pts (8%), all had LS, developed brain metastases. Median follow-up was 59.5 months (1.9-234.1). Median PFS (95%CI) for LS pts was 39.2 months (15.1-not estimable) vs 2.9 months (0.9-4.6) for ES. Median OS(95%CI) was 31.8 months (16.3-56.0) for the whole cohort, 52.8 months (31.8-not estimable) for LS and 5.9 months(1.8-16.3) for ES. Conclusions: In the LS SCCC cohort treated with concurrent cisplatin/etoposide chemo/RT and outback cis/etoposide +/- post initial radical hysterectomy the 5-year PFS (95%CI) was 37.5% (19.2-55.9%). Clinicopathologic characteristics and risk factors for SCCC appear distinct to cervical cancers and lung small cell cancers. Further investigation of molecular alterations and treatment of this rare tumor is needed to improve pt outcomes. [Table: see text]

Characterization of radiation-induced cavernous malformations and comparison with a nonradiation cavernous malformation cohort

OBJECT The objective of this study was to characterize the clinical features of radiation-induced cavernous malformations (RICMs). METHODS The authors retrospectively reviewed the clinical and radiological characteristics of patients with RICMs. The features of these RICMs were then compared with features of nonradiation cavernous malformations (CMs) in 270 patients. RESULTS Thirty-two patients with RICMs were identified (56.2% men), with a median age of 31.1 years at RICM diagnosis. The median latency from radiation treatment to RICM diagnosis was 12.0 years (interquartile range 5.0–19.6 years). RICMs were always within the previous radiation port. RICMs were symptomatic at diagnosis in 46.9%, and were associated with symptomatic intracranial hemorrhage at any time in 43.8%. Older age at the time of radiation treatment and higher radiation dose were associated with shorter latency. RICMs tended to be diagnosed at a younger age than nonradiation CMs (median 31.1 vs 42.4 years, respectively; p = 0.054) but were significantly less likely to be symptomatic at the time of diagnosis (46.9% vs 65.8%, respectively; p = 0.036). RICMs were more likely to be multiple CMs than nonradiation CMs (p = 0.0002). Prospectively, the risk of symptomatic hemorrhage was 4.2% for RICMs and 2.3% for nonradiation CMs per person-year (p = 0.556). In the absence of symptoms at presentation, the risk of hemorrhage for RICMs was higher than for nonradiation CMs (4.2% vs 0.35%, respectively; p = 0.118). CONCLUSIONS In this patient population, RICMs occurred within the radiation port approximately 12 years after radiation treatment. Compared with nonradiation CMs, RICMs were more likely to occur as multiple CMs, to present at a younger age, and were at least as likely to cause symptomatic hemorrhage.