Incidence of ovarian metastasis in neuroendocrine tumors of the cervix

Abstract

<h3>Objectives:</h3> To report on the incidence of ovarian metastasis in patients with high grade neuroendocrine tumors of the cervix (NEC) who underwent surgical resection. <h3>Methods:</h3> This was a single institution retrospective chart review. The electronic medical record was searched for all patients with a diagnosis of NEC at The Ohio State University from January 2010 to March 2020. Patients without complete pathologic records were excluded. <h3>Results:</h3> From January 2010 to March 2020, 43 patients were identified with NEC. Of those patients, 16 had undergone surgical resection including hysterectomy, bilateral salpingectomy and oophorectomy, and lymph node dissection. Of the 16 patients, zero had evidence of metastatic disease to their ovaries. The median age of patients in our cohort was 35.5 years with a mean age of 40.5 (28-70y). 13 of the 16 patients were considered pre-menopausal at the time of their surgery (defined as age 50 or younger). Of the 16 patients who underwent surgical management, 2 had adjuvant chemotherapy alone, 7 had adjuvant chemotherapy with adjuvant radiotherapy, 2 had adjuvant chemoradiotherapy, and 3 had adjuvant radiation therapy. Of the 16 patients in the study, 13 received neoadjuvant chemotherapy as part of their treatment. For those who had chemotherapy as part of their treatment plan, the most commonly used regimen was cisplatin with etoposide with a median of 3 cycles neoadjuvant and 3 cycles in the adjuvant setting. Based on the FIGO 2018 staging classifications, 6 patients had stage I disease (1 1A2, 2 IB1, 1 IB2, 2 IB3). 10 of the 16 patients had advanced stage disease defined as IIB through IVB (2 IIB, 1 IIIB, 3 IIIC1, 2 IIIC2, 2 IVB). <h3>Conclusions:</h3> The incidence of ovarian metastasis in patients with NEC has not been reported in the literature. Here we demonstrate in our limited series that ovarian metastasis in NEC of the cervix is rare. Current practice of ovarian retention in NEC is based on expert opinion and is not standard of care across the field of gynecologic oncology. Our data support that ovarian retention in NEC is safe. Previously published data from our institution demonstrate that 82% of patients with stage I disease had no evidence of disease at time of their last follow up with the use of a multimodality treatment approach (McCann 2013). In our cohort, radiation therapy is often employed in the treatment of NEC. Ovarian retention with transposition out of the radiated field may be a reasonable option for women who would benefit from preservation of ovarian function. Commonly used chemotherapeutic agents were cisplatin with etoposide, both with limited gonadotoxicity. Given the low incidence of ovarian metastasis in NEC, ovarian cryopreservation or oocyte harvesting is a reasonable option for patients who desire the ability to have offspring with the assistance of a surrogate in the future. Further studies with a multi-institutional collaboration to better define the incidence of NEC metastasis to the ovary is necessary.