Salvage sequential integrated boost radiotherapy followed by sintilimab–bevacizumab in cervical small-cell carcinoma with >10 brain metastases: A 3-year survivor case report

TL;DR

A 54-year-old woman with cervical small-cell carcinoma and multiple brain metastases survived 3 years using a combination of radiotherapy and immunotherapy.

Contribution

A novel multimodal treatment approach for CSCC with >10 brain metastases is described, achieving a 3-year survival.

Findings

WBRT combined with SEB improved metastatic dose coverage in a patient with 16 brain metastases.

Immunotherapy with sintilimab and bevacizumab induced complete remission after radiation recurrence.

The patient achieved 3-year survival without significant cognitive impairment.

Abstract

Cervical small cell carcinoma (CSCC) is a rare and highly aggressive malignancy with a poor prognosis. Brain metastases develop in 10–20% of patients, complicating clinical management and underscoring the need for effective therapeutic strategies.

A 54-year-old female with CSCC developed 16 isolated brain metastases during treatment. She responded markedly to whole-brain radiotherapy (WBRT) combined with sequential integrated boost radiotherapy (SEB). Although recurrence emerged outside the SEB field one year later, subsequent treatment with immune checkpoint inhibitors and antiangiogenic agents induced complete remission (CR), achieving a progression-free survival (PFS) of 16 months. Remarkably, the patient has achieved an overall survival of 3 years since the diagnosis of brain metastases, without significant treatment-related cognitive impairment, and remains in CR.

The combination of WBRT and SEB improves metastatic dose coverage in CSCC patients with multiple brain metastases. Furthermore, combining immunotherapy with antiangiogenic therapy demonstrates significant efficacy against post-radiation intracranial recurrence, supporting a multimodal individualized approach for further study.

Figures