Completion of and early response to chemoradiation among human immunodeficiency virus (HIV)‐positive and HIV‐negative patients with locally advanced cervical carcinoma in South Africa

Abstract

Background Very few published studies have dealt with the management of locally advanced cervix carcinoma among HIV-positive patients. The objective was to compare the clinical characteristics, radiation and chemotherapy treatments, and outcomes in a cohort of HIV-positive and –negative women with cervical cancer. Methods We reviewed the charts of 59 HIV-positive patients and 324 HIV-negative patients with stage IBi – IIIB cervical carcinoma, who received radiation therapy. We compared demographic and clinical characteristics at diagnosis and radiation dose, chemotherapy cycles, and response at time of brachytherapy and six-week follow-up. We developed logistic regression models of response to treatment. Results 49 (88.1%) of the HIV-positive patients but only 213 (65.7%) HIV-negative patients presented with stage IIIB disease (p=0.009). 47 (79.7%) HIV-positive patients and 291(89.8%) HIV-negative patients completed the equivalent radiation dose of 68Gy EBRT and HDR brachytherapy (p=0.03). Of the 333 patients who commenced concurrent chemotherapy, 26 (53.1%) HIV-positive patients and 212 (74.6%) HIV-negative patients completed four or more weekly cycles of platinum-based treatment. Follow-up was censured at six weeks. In models that included age, stage, HIV status, and treatment, poor response at six weeks was associated only with having stage IIIB disease (OR=2.39, 95%CI 1.45 – 3.96) and receiving less than 68Gy EQD2 radiation (OR=3.14, 95%CI 1.24 – 7.94). Conclusions HIV-positive patients fared worse than HIV-negative patients due to later presentation and a decreased likelihood of completion of treatment. Our findings emphasise the importance of completing irradiation therapy. Further studies will address the association of these variables with survival.

Outcomes after Radiation Therapy for HIV Positive Patients with Invasive Cervical Cancer

“…For the CRT part, the median dose given to the pelvis was 45 Gy, dose similar to those recommended (Simonds et al, 2012, Simonds et al, 2015, Ferreira et al, 2017, Shrivastava et al, 2005 but the median EqD2 dose received by the cervical tumor, taking into account brachytherapy or the centro-pelvic boost was only 59.7 Gy. This dose is lower than the dose of 68 Gy considered adequate after CRT and brachytherapy (Simonds et al, 2012, Simonds et al, 2015. Brachytherapy, indicated in 18 cases (IB2 to IIIB), could not be performed in 9 patients (32.1%) due to complication of CRT.…”

“…Another limitation of our study is the low number of included patients. We studied 28 patients while the main series published included between 36 and 87 patients (Simonds, Wright, du Toit, Neugut & Jacobson, 2012, Simonds, Neugut & Jacobson, 2015, Ferreira et al, 2017, Shrivastava, Engineer, Rajadhyaksha & Dinshaw, 2005 The four major studies have been carried out in developing countries where the incidence of CCU and HIV is higher than in France.…”

“…Only 22 patients completed EBRT. Simonds et al (2012) published a retrospective study of 461 patients treated in South Africa and 59 of whom were HIV-positive. Only 79% of HIV positive patients received a total dose of at least 68 Gy versus 90% of HIV negative patients (p=0.03).…”

Effect of AIDS on Women Who Have Sex-Determined Health Issues

“…This will be exaggerated in HIV-positive patients who fare worse than HIV-negative patients owing to later presentation and a decreased likelihood of completion of treatment. 55 Imaging with 195m Pt-radiolabeled cisplatinum could provide information that may help better understand the mechanisms of action as well as the metabolic conversion of cisplatinum in humans and related toxicity (Fig. 2).…”

Estimating the burden of cervical disease among HIV-infected women accessing screening services in South Africa: A model-based analysis

“…[4] Cervical disease also appears to be harder to treat in HIV-infected women, with lower cure rates achieved in this population. [5,6] South Africa (SA) is home to the largest number of HIV-infected individuals in the world, [3] with nearly 60% of incident HIV infections occurring in women. [7] The country's age-standardised incidence of cervical cancer is 32 per 100 000, [8] which is one of the highest rates in the world.…”