The impact of HIV infection on survival and acute toxicities from chemoradiation therapy for cervical cancer patients in a limited resource setting

Publication date: Available online 1 February 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Surbhi Grover, Memory Bvochora-Nsingo, Alyssa Yeager, Sebathu Chiyapo, Rohini Bhatia, Emily MacDuffie, Priya Puri, Dawn Balang, Sarah Ratcliffe, Mohan Narasimhamurthy, Elliphine Gwangwava, Sylvia Tsietso, Mukendi K.A. Kayembe, Doreen Ramogola-Masire, Scott Dryden-Peterson, Umesh Mahantshetty, Akila N. Viswanathan, Nicola M. Zetola, Lilie L. Lin
PurposeCervical cancer is the leading cause of cancer death for women in sub-Saharan Africa. Human immunodeficiency virus (HIV) infection increases the risk of cervical cancer. However, prospective data on the outcomes of cervical cancer patients with HIV infection treated with curative intent are limited.MethodsWomen with locally advanced cervical cancer with or without HIV infection initiating radical chemoradiation therapy (CRT) in Botswana were enrolled in a prospective observational cohort study from July 2013 through January 2015.ResultsOf 182 women treated for cervical cancer during the study period, 143 women initiating curative CRT were included in the study. Eighty-five percent of the participants (122/143) had stage II/III cervical cancer, and 67% (96/143) were HIV-infected. All HIV-infected patients were on anti-retroviral treatment (ART) at the time of curative cervical cancer treatment initiation. We found no difference in toxicities between HIV-infected and HIV-uninfected women. The two-year overall survival (OS) rates were 65% for HIV-infected women (95% confidence interval [CI] 54-74%) and 66% for HIV-uninfected women (95% CI 49-79%) (p=0.70). Factors associated with better two-year OS on multivariate analyses included baseline hemoglobin >10 g/dL (hazard ratio [HR] 0.37, 95% CI 0.19-0.72, p=0.003), total radiation dose ≥75 Gy (HR 0.52, 95% CI 0.27-0.97, p=0.04), and age <40 years vs. 40-59 years (HR 2.17, 95% CI 1.05-4.47, p=0.03).ConclusionsHIV status had no effect on two-year OS or on acute toxicities in women with well-managed HIV infection who initiated curative CRT in Botswana. In our cohort, we found that baseline hemoglobin levels, total radiation dose, and age were associated with survival, regardless of HIV status.



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