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

BACKGROUND:

Very few published studies have dealt with the management of locally advanced cervix carcinoma among human immunodeficiency virus (HIV)‐positive patients. The objective of this study was to compare the clinical characteristics, radiation and chemotherapy treatments, and outcomes in a cohort of HIV‐positive and HIV‐negative women with cervical cancer.

METHODS:

The authors reviewed the charts of 59 HIV‐positive patients and 324 HIV‐negative patients who had stage IB1 to IIIB cervical carcinoma and who received radiation therapy. Demographic and clinical characteristics were compared at the time of diagnosis; and radiation doses, chemotherapy cycles, and responses were compared at the time of brachytherapy and at 6‐week follow‐up. Logistic regression models of response to treatment were developed.

RESULTS:

Forty‐nine HIV‐positive patients (88.1%) but only 213 HIV‐negative patients (65.7%) presented with stage IIIB disease (P = .009). Forty‐seven HIV‐positive patients (79.7%) and 291 HIV‐negative patients (89.8%) completed the equivalent dose of 68 Grays (Gy) external‐ beam radiation and high‐dose‐rate brachytherapy. (P = .03). Of the 333 patients who commenced concurrent chemotherapy, 26 HIV‐positive patients (53.1%) and 212 HIV‐negative patients (74.6%) completed ≥4 weekly cycles of platinum‐based treatment. Follow‐up was censured at 6 weeks. In models that included age, disease stage, HIV status, and treatment, a poor response at 6 weeks was associated only with stage IIIB disease (odds ratio, 2.39; 95% confidence interval, 1.45‐3.96) and receiving an equivalent radiation dose in 2‐Gy fractions of <68 Gy (OR, 3.14; 95% CI, 1.24‐7.94).

CONCLUSIONS:

HIV‐positive patients fared worse than HIV‐negative patients because of later presentation and a decreased likelihood of completing treatment. The current findings emphasize the importance of completing irradiation therapy. Further studies will address the association of these variables with survival. Cancer 2011. © 2011 American Cancer Society.