HIV Status and Acute Hematologic Toxicity Among Patients With Cervix Cancer Undergoing Radical Chemoradiation
Open Access
- 1 June 2015
- journal article
- research article
- Published by BMJ in International Journal of Gynecologic Cancer
- Vol. 25 (5), 884-890
- https://doi.org/10.1097/igc.0000000000000441
Abstract
Introduction Women infected with the human immunodeficiency virus (HIV) have a higher risk of developing cervix carcinoma than do other women who are thought to be more vulnerable to acute toxicities during chemoradiation. We compared HIV-positive/HIV-negative patients with cervix carcinoma at a single institution with respect to cancer treatment toxicities. Methods and Materials Among patients with stage Ib1-IIIb invasive cervical carcinoma who received radiation or chemoradiation with curative intent, we evaluated demographic and clinical characteristics of HIV-positive and HIV-negative patients. Treatment regimens were documented and toxicities scored as per Radiation Therapy Oncology Group guidelines. We developed logistic regression models for the associations of grade 3/4 toxicities with HIV status. Results Complete data were available on 213 patients, including 36 (16.8%) who were HIV positive. More than 85% of both HIV-positive and HIV-negative patients received a minimum of 68-Gy equivalent dose in 2-Gy-fraction external beam and high-dose-rate brachytherapy. More HIV-positive than HIV-negative patients were prescribed radiation alone (38.9% vs 24.29%, P = 0.01), experienced at least 1 grade 3/4 toxicity (38.9% vs 26.6%), or developed grade 3/4 leucopenia (30.6% vs 10.2%, P = 0.003). In a multivariable model, patients who developed a grade 3/4 toxicity were 4 times as likely to have received chemotherapy (odds ratio, 4.41 [95% confidence interval, 1.76–11.1]; P = 0.023) and twice as likely to be HIV positive (odds ratio 2.16 [95% confidence interval, 0.98–4.8]; P = 0.05) as women who did not experience such toxicities. Conclusions HIV-positive patients with cervical carcinoma received adequate radiotherapy but were less likely than HIV-negative patients to complete chemotherapy. Few HIV-positive or HIV-negative patients who received radiotherapy without chemotherapy experienced grade 3/4 toxicity. However, among patients who received chemotherapy, those who were HIV positive were more likely than others to experience hematologic toxicity.Keywords
This publication has 13 references indexed in Scilit:
- Human Papillomavirus Infection and Related Cancers in Sub-Saharan Africa: Burden and Tools for PreventionVaccine, 2013
- Completion of and early response to chemoradiation among human immunodeficiency virus (HIV)-positive and HIV-negative patients with locally advanced cervical carcinoma in South AfricaCancer, 2011
- Concurrent chemoradiotherapy with 5-fluorouracil and mitomycin C for anal carcinoma: Are there differences between HIV-positive and HIV-negative patients in the era of highly active antiretroviral therapy?Radiotherapy and Oncology, 2011
- Issues in cervical cancer incidence and treatment in HIVCurrent Opinion in Oncology, 2010
- HIV-Specific Differences in Outcome of Squamous Cell Carcinoma of the Anal Canal: A Multicentric Cohort Study of HIV-Positive Patients Receiving Highly Active Antiretroviral TherapyJournal of Clinical Oncology, 2008
- Long-Term Follow-Up of a Randomized Trial Comparing Concurrent Single Agent Cisplatin, Cisplatin-Based Combination Chemotherapy, or Hydroxyurea During Pelvic Irradiation for Locally Advanced Cervical Cancer: A Gynecologic Oncology Group StudyJournal of Clinical Oncology, 2007
- Unexpectedly high rates of grade 3 and 4 acute toxicity in the treatment of cervical cancer in sub-Saharan AfricaGynecologic Oncology, 2007
- A phase I study of concurrent cisplatin chemotherapy in patients with carcinoma of the cervix receiving pelvic radiotherapyInternational Journal of Gynecologic Cancer, 2006
- HIV impact on acute morbidity and pelvic tumor control following radiotherapy for cervical cancerGynecologic Oncology, 2006
- A simple method of obtaining equivalent doses for use in HDR brachytherapyInternational Journal of Radiation Oncology*Biology*Physics, 2000