Gurram Lavanya, Mohanty Samarpita, Chopra Supriya, Grover Surbhi, Engineer Reena, Gupta Sudeep, Ghosh Jaya, Gulia Seema, Sawant Sheela, Daddi Anuprita, Deodhar Kedar, Menon Santosh, Rekhi Bharat, Shylasree T S, Maheshwari Amita, Mahantshetty Umesh
Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
JCO Glob Oncol. 2022 Mar;8:e2100312. doi: 10.1200/GO.21.00312.
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.
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.
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/mm (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 brachytherapy, the median prescription dose was 80 Gy. Seventy-seven patients completed their prescribed treatment. At a median follow-up of 37 months, 3-year disease-free survival of patients planned with curative-intent was 54%. On multivariate analysis, treatment completion was associated with favorable disease-free survival. Grade III/IV acute gastrointestinal toxicity was seen in five (6.8%) patients, whereas 30% patients had grade III/IV acute hematologic toxicity. All these patients completed their planned radiotherapy with good supportive care.
Standard treatment of chemoradiation should be planned in women living with HIV with well-managed HIV presenting with locally advanced cervical cancer. Our study highlights the need for optimal management of these patients by a multidisciplinary team with intensive supportive care to ensure completion of planned treatment to achieve better outcomes.
在现代抗逆转录病毒治疗时代，关于感染人类免疫缺陷病毒（HIV）的女性宫颈癌管理的数据有限。本研究旨在评估接受放射治疗的这些患者的治疗结果和毒性。
在印度一家三级医疗中心对2011年至2018年间接受放射治疗的HIV阳性宫颈癌患者进行回顾性分析。
确定了82例接受放射治疗的HIV阳性宫颈癌患者。她们的中位年龄为45岁。74例（90%）患者接受了根治性放疗，8例患者接受了姑息性放疗。治疗开始时的中位CD4细胞计数为342个/立方毫米（四分位间距：241 - 531）。在计划进行根治性放疗的患者中，52例（70%）患者计划同时使用顺铂，化疗周期中位数为4个，81%（n = 60）的患者接受了近距离放疗。在接受近距离放疗的患者中，中位处方剂量为80 Gy。77例患者完成了规定的治疗。在中位随访37个月时，计划进行根治性治疗的患者3年无病生存率为54%。多因素分析显示，治疗完成与良好的无病生存率相关。5例（6.8%）患者出现III/IV级急性胃肠道毒性，而30%的患者出现III/IV级急性血液学毒性。所有这些患者在良好的支持治疗下完成了计划的放疗。
对于感染HIV且HIV病情得到良好控制、患有局部晚期宫颈癌的女性，应计划进行标准化的放化疗治疗。我们的研究强调，需要由多学科团队对这些患者进行最佳管理，并提供强化支持治疗，以确保完成计划的治疗，从而取得更好的结果。
