Outcomes after Radiation Therapy for HIV Positive Patients with Invasive Cervical Cancer

Abstract

Objective: To assess tolerance, local control, and survival outcomes for HIV (human immunodeficiency virus) positive patients with locally advanced cervical cancer (CC) treated with external beam radiation therapy (EBRT) and/or brachytherapy from an Assistance Publique - Hopitaux de Paris (APHP) retrospective cohort.Methods: Between 2000 and 2014, 28 HIV positive patients presenting with a non-metastatic CC were treated in one of the five APHP radiation therapy centers. Fifteen patients (54%) underwent primary surgery. Twenty-four patients (88%) received EBRT, with concurrent chemotherapy in 22 cases, and 68% received brachytherapy.Results: The median follow-up was 58 months. At 5 years, local control (LCR) and overall survival rates (OS) were 56% and 46.5% respectively. A grade 3-4 acute toxicity (mainly hematological toxicity) was reported in 18 patients (64%). In univariate analysis, total irradiation dose (p=0.03) and cisplatin-based chemotherapy (p=0.005) were predictive of acute toxicity. A grade 3-4 late toxicity (mainly gastro-intestinal and renal) was observed in 7 patients (25%). In univariate analysis, HIV stage at diagnosis (p=0.02) and an initial CD4 count <200/mm3 (p=0.03) were predictive factors of late toxicity.Conclusion: In this study including HIV positive patients with CC, local control and overall survival rates seemed to be lower than those reported in the literature for non-HIV patients. We also reported an increase in acute and late toxicity, mainly hematological, underlying the fundamental role of immunosuppression in tolerance to radiation therapy.