Long-Term Disease-Free Survival After Systemic-First Sequential Multimodal Therapy for Advanced and Recurrent Large-Cell Neuroendocrine Carcinoma of the Uterine Cervix: A Case Report.

Cervical large-cell neuroendocrine carcinoma (LCNEC) is a rare and highly aggressive malignancy with poor prognoses, particularly in advanced or recurrent disease. We describe a case of advanced and recurrent cervical LCNEC in which long-term disease-free survival was achieved following a systemic-first, sequential multimodal treatment strategy. A 41-year-old woman presented with abnormal vaginal bleeding and was diagnosed with cervical LCNEC with pelvic and para-aortic lymph node metastases. Neoadjuvant irinotecan-cisplatin chemotherapy resulted in marked tumor regression, enabling radical hysterectomy. Postoperative therapy consisted of etoposide-cisplatin chemotherapy, followed by pelvic and para-aortic radiotherapy. Mediastinal lymph node recurrence developed 3 years later and was successfully treated using the same chemotherapy regimen combined with site-directed radiotherapy, resulting in complete remission. The patient remained disease-free 9 years after the final treatment completion. This case suggests that carefully sequenced systemic chemotherapy, surgery, and radiotherapy integration may provide durable disease control in selected patients with advanced or recurrent cervical LCNEC.