Long-term remission of clear cell carcinoma of the cervix after chemoradiation with 109 cycles of paclitaxel: a case report and literature review

Background: Clear cell carcinoma of cervix (CCCC) is a rare cervical neoplasm that is usually associated with diethylstilbestrol (DES) exposure in utero as a primary risk factor. Advanced stage disease typically has poor outcomes and no evidence-based approach exists to guide clinicians in treating this rare disease. Case: The authors report a case of locally advanced CCCC in a 37-year-old Caucasian female. She underwent chemoradiation therapy that included 109 courses of paclitaxel chemotherapy until no disease could be detected on imaging studies. She is now disease-free 13 years after discontinuing chemotherapy. Conclusion: A prolonged course of single agent paclitaxel after completing standard radiation therapy was successful in achieving remission in a patient with this rare disease.

Clear cell carcinoma of the cervix; Paclitaxel; Chemotherapy.

[1] Herbet A.L.: “Behavior of estrogen associated female genital tract cancer its relation to neoplasia following intrauterine exposure to diethylstilbestrol( DES)”. Gynecol Oncol., 2000, 76, 147.

[2] Hanselaar A., van Loosbroek M., Schuurbiers O., Helmerhorst T., Bulten J., Bernheim J.: “Clear cell adenocarcinoma of the vagina and cervix. An update of the central Netherlands registry showing twin age incidence peaks”. Cancer, 1997, 79, 2229.

[3] Noller K.L., Decker D.G., Dockery M.B., Lanier A.P., Smith R.A., Symmonds R.E.: “Mesonephric (clear cell) carcinoma of the vagina and cervix. A retrospective analysis. Obstet Gynecol 1974;43:640–4.

[4] Kaminski PF, Maier RC. Clear cell adenocarcinoma of the cervix unrelated to diethylstilbestrol exposure”. Obstet Gynecol., 1983, 62, 720.

[5] Reich O., Tamussino K., Lahousen M., Pickel H., Haas J., Winter R.: “Clear cell carcinoma of the uterine cervix: pathology and prognosis in surgically treated stage IB–IIB disease in women not exposed in utero to diethylstilbestrol”. Gynecol Oncol., 2000, 76, 331.

[6] Hasegawa K., Nagao S., Yasuda M., Millan D., Viswanathan A.N., Glasspool R.M., et al.: “Gynecologic Cancer InterGroup (GCIG) consensus review for clear cell carcinoma of the uterine corpus and cervix”. Int. J. Gynecol. Cancer, 2014, 24, S90.

[7] Thomas M.B., Wright J.D., Leiser A.L., Chi D.S., Mutch D.G., Podratz K.C., Dowdy S.C.: “Clear cell carcinoma of the cervix: a multiinstitutional review in the post-DES era”. Gynecol. Oncol., 2008, 109, 335.

[8] Curtin J.P., Blessing J.A., Webster K.D., Rose P.G., Mayer A.R., Fowler W.C. Jr., et al.: “Paclitaxel, an active agent in nonsquamous carcinomas of the uterine cervix: a Gynecologic Oncology Group Study”. J. Clin. Oncol., 2001, 19, 1275.

[9] National Cancer Institute: “Taxol® (NSC 125973)”. Available at: http://dtp.nci.nih.gov/timeline/flash/success_stories/S2_taxol.htm

[10] Bookman M.A.: “First-line chemotherapy in epithelial ovarian cancer”. Clin. Obstet. Gynecol., 2012, 55, 96.

[11] Minagawa Y., Shimada M., Itamochi H., Sato S., Sato S., Okada M., et al.: “Feasibility study on biweekly paclitaxel treatment as maintenance chemotherapy in advanced müllerian carcinoma”. Gynecol. Obstet. Invest., 2012, 73, 272.

[12] Gadducci A., Katsaros D., Zola P., Scambia G., Ballardini M., Pasquini E., et al.: “Weekly low-dose paclitaxel as maintenance treatment in patients with advanced ovarian cancer who had microscopic residual disease at second-look surgery after 6 cycles of paclitaxel/platinum-based chemotherapy: results of an open noncomparative phase 2 multicenter Italian study (After-6 Protocol 2)”. Int. J. Gynecol. Cancer, 2009, 19, 615.

[13] Robinson W.R., Davis N., Rogers A.S.: “Paclitaxel maintenance chemotherapy following intraperitoneal chemotherapy for ovarian cancer”. Int. J. Gynecol. Cancer, 2008, 18, 891.

[14] Mei L., Chen H., Wei D.M., Fang F., Liu G.J., Xie H.Y., et al.: “Maintenance chemotherapy for ovarian cancer”. Cochrane Database Syst. Rev., 2013, 6, CD007414

[15] Green J., Kirwan J., Tierney J., Vale C., Symonds P., Fresco L., et al.: “Concomitant chemotherapy and radiotherapy for cancer of the uterine cervix”. Cochrane Database Syst. Rev., 2005, 3, CD002225

[16] McQuellon R.P., Thaler H.T., Cella D., Moore D.: “Quality of life outcomes from a randomised trial of cisplatin versus cisplatin plus paclitaxel in advanced cervical cancer: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2006, 101, 296.

[17] Moore D.H., Blessing J.A., McQuellon R.P., Thaler H.T., Cella D., Benda J., et al.: “Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study”. J. Clin. Oncol., 2004, 22, 3113.

[18] Monk B.J.: “A randomised phase III trial of four cisplatin containing doublet combinations in stage IVB, recurrent or persistent cervical carcinoma: a GOG study”. J. Clin. Oncol., 2008, 26, 15S.

[19] Mountzios G., Dimpoulos M.A., Bamias A., Vourli G., Kalofonos H., Aravantinos G., et al.: “Randomised multicentre phase II trial of cisplatin and ifosfamide with or without paclitaxel in recurrent or metastatic carcinoma of the uterine cervix: a Hellenic Co-operative Oncology Group (HeCOG) study”. Ann. Oncol., 2009, 20, 1362.

[20] Scatchard K., Forrest J.L., Flubacher M., Cornes P., Williams C.: “Chemotherapy for metastatic and recurrent cervical cancer”. Cochrane Database Syst. Rev., 2012, 10, CD006469.

[21] Gynecologic Oncology Group: “A phase III trial of adjuvant chemotherapy following chemoradiation as primary treatment for locally advanced cervical cancer compared to chemoradiation alone: The OUTBACK Trial”. Available at: http://clinicaltrials.gov/show/NCT01414608