HIV infection and invasive cervical cancers, treatment with radiation therapy: toxicity and outcome (original) (raw)
Related papers
JCO Global Oncology, 2022
PURPOSE There are limited data on management of cervical cancer in women living with HIV in the modern antiretroviral therapy era. The study aimed to evaluate outcomes and toxicities of these patients treated with radiotherapy. MATERIALS AND METHODS A retrospective analysis of HIV-positive cervical cancer patients treated with radiotherapy between 2011 and 2018 was conducted at a tertiary care center in India. RESULTS Eighty-two HIV-positive cervical cancer patients treated with radiotherapy were identified. Their median age was 45 years. Seventy-four (90%) patients received radiotherapy with curative-intent and eight patients received palliative radiotherapy. Median CD4 count at the start of treatment was 342 cells/mm3 (interquartile range: 241-531). Among patients planned for definitive radiotherapy, concurrent cisplatin was planned in 52 (70%) patients with a median of four chemotherapy cycles, and 81% (n = 60) patients received brachytherapy. Among patients who received brachyth...
JCO Global Oncology
PURPOSE We annually treat more than 800 new patients with cervical cancer, where the majority (approximately 60%) have locally advanced disease and approximately 40% of them are infected with HIV. To optimally care for this large number of patients in low-income settings is difficult. From July 2011, we started using 45.0 Gy/15# hypofractionated radiotherapy (HFRT) as a substitute to 50.0 Gy/25# conventional fractionated radiotherapy (CFRT), for the treatment of locally advanced cervical cancer (LACC). This study aims at comparing the 5-year treatment outcomes between patients with LACC, known HIV serostatus, and treated with either CFRT or HFRT. METHODS A retrospective study was conducted according to demographic/clinical data, radiotherapy fractionations, and outcomes. Factors considered were FIGO stages IIB-IIIB, known HIV serostatus, and had completed external-beam radiotherapy and intracavitary brachytherapy. The primary end point was overall survival; the secondary end points ...
International Journal of Gynecologic Cancer, 2021
ObjectiveCervical cancer remains the most common cancer among women in sub-Saharan Africa and is also a leading cause of cancer related deaths among these women. The benefit of chemoradiation in comparison with radiation alone for patients with stage IIIB disease has not been evaluated prospectively in women living with human immunodeficiency virus (HIV). We assessed the survival of chemoradiation versus radiation alone among stage IIIB cervical cancer patients based on HIV status.MethodsBetween February 2013 and June 2018, patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIIB cervical cancer with or without HIV and treated with chemoradiation or radiation alone, were prospectively enrolled in an observational cohort study. Overall survival was evaluated using the Kaplan–Meier method. Cox proportional hazards modeling was used to analyze associations with survival.ResultsAmong 187 patients, 63% (n=118) of women had co-infection with HIV, and 48% ...
2012
This was a retrospective study on the results of curative radiotherapy (with or without chemotherapy) for the treatment of cervical carcinoma patients who were infected with human immunodeficiency virus. This study was carried out in the Division of Therapeutic Radiology and Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University. Fifty-four patients were studied retrospectively from 2004 to 2009 and the CD4+ T cell count was assessed in 29 patients. According to FIGO staging, 25, 19, 9 patients and 1 patient were stage I, II, III and IV, respectively. The 2-year local control, disease-free survival and distant metastasis-free survival rates were 92.6%, 87% and 83.3%, respectively. During treatment, four (7.4%) and three (5.5%) patients developed grade 3-4 anemia and leucopenia, respectively. Serious late toxicity was observed in two patients with grade 3 hematuria.
Southern African Journal of Gynaecological Oncology, 2016
Background: The current standard of radical treatment for patients with cancer of the cervix is combination therapy in the form of radiotherapy with chemotherapy. Generally the same treatment protocol is applied to HIV-positive and HIV-negative patients. However, HIV-positive patients with invasive cervical cancer have not been evaluated in detail regarding treatment response, its toxicities and compliance. Methods: This prospective, quantitative comparative study was conducted to evaluate acute toxicity in radical combination therapy, in HIV-positive (on HAART) and HIV-negative patients for cervical cancer at the Cancer Diseases Hospital, Lusaka, Zambia. In total, 120 stage IB 2-IIIB cervical cancer patients were serially recruited to have an equal number of participants in each arm. Participants received cisplatin-based radical chemo-radiation for five to six weeks and were assessed for acute reactions in four systems: genitourinary, haematopoietic, skin, and gastrointestinal. Toxicity was scored using the NCI CTC v2.0. Results: The results revealed that there was no significant difference with regard to major acute reactions between the two groups. Radical chemo-radiation is therefore well tolerated by HIV-positive patients. Conclusion: Radical chemo-radiation in conventional doses was safely tolerated by a well-selected cervical cancer HIV-positive group on HAART and could be considered suitable for similar patients.
Cervical Cancer Treatment in HIV-Positive Patients: A Survey of Treatment Practices in India
JCO Global Oncology, 2021
PURPOSE Chemoradiation remains a challenge in women living with HIV (WLWH) and cervical cancer primarily because of concerns regarding immune status. With limited literature available to help guide the management of these patients, clinical practices among oncologists are variable across India. Hence, we conducted a survey among radiation oncologists in India to assess the patterns of current practices of treating cervical cancer with chemoradiation in WLWH. MATERIALS AND METHODS A questionnaire consisting of 12 questions related to the treatment of cervical cancer in WLWH was distributed to radiation oncologists at two national conferences in India. RESULTS The questionnaire was distributed to 105 radiation oncologists, and 90 (85.7%) responses were received. 95.5% of respondents reported that patients with advanced cervical cancer constituted the majority of their practice. Chemoradiation was reported as the most common modality of planned treatment. Ninety-four percentage of resp...
Cancer, 2011
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
The impact of HIV infection on women receiving radiation for cervical cancer
Southern African Journal of Gynaecological Oncology, 2015
Background: The objective of the study was to compare patient characteristics, treatment toxicity and interruptions, and survival in human immunodeficiency virus (HIV)-positive and HIV-negative cervical cancer patients receiving radiation as primary or adjuvant treatment. Method: Demographics, clinical and tumour characteristics, and the outcomes of 51 HIV-positive and 47-HIV negative consecutive cervical cancer patients were assessed and compared, including co-morbidities, performance status, treatment type and toxicities, and survival. Results: HIV-positive women were 13 years younger (p < 0.001), more often had anaemia (p 0.021) and needed pretreatment blood transfusion (p 0.037) more often than HIV-negative women. Performance status, kidney function, International Federation of Gynecology and Obstetrics stage, histology types and treatment intent and planning did not differ between the two groups. Treatment interruptions (p 0.004), transfusion during treatment (p 0.012), treatment toxicities (p 0.040) and average deficit (p 0.021) occurred significantly more in HIV-positive patients. Survival was significantly worse in HIV-positive women (p 0.029) and was associated with insufficient radiation (p < 0.001) and treatment interruptions (p 0.051). Conclusion: In spite of being younger, the pretreatment correction of anaemia and the prescription of sufficient radiation dosages, HIV-infected cervical cancer patients experienced poorer survival. Treatment interruption and incomplete radiation contributed to poor outcomes.
Southern African Journal of Gynaecological Oncology, 2016
Background: The current standard of radical treatment for patients with cancer of the cervix is combination therapy in the form of radiotherapy with chemotherapy. Generally the same treatment protocol is applied to HIV-positive and HIV-negative patients. However, HIV-positive patients with invasive cervical cancer have not been evaluated in detail regarding treatment response, its toxicities and compliance. Methods: This prospective, quantitative comparative study was conducted to evaluate acute toxicity in radical combination therapy, in HIV-positive (on HAART) and HIV-negative patients for cervical cancer at the Cancer Diseases Hospital, Lusaka, Zambia. In total, 120 stage IB2–IIIB cervical cancer patients were serially recruited to have an equal number of participants in each arm. Participants received cisplatin-based radical chemo-radiation for five to six weeks and were assessed for acute reactions in four systems: genitourinary, haematopoietic, skin, and gastrointestinal. Toxi...