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HIV Status and Acute Hematologic Toxicity Among Patients With Cervix Cancer Undergoing Radical Chemoradiation
  1. Hannah M. Simonds, MBChB, MRCP, FRCR*,
  2. Alfred I. Neugut, MD, PhD,,§ and
  3. Judith S. Jacobson, DrPH, MBA,
  1. *Division of Radiation Oncology, Tygerberg Hospital/University of Stellenbosch, Stellenbosch, South Africa;
  2. Herbert Irving Comprehensive Cancer Centre, Columbia University, New York, NY;
  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and
  4. §Division of Oncology, Columbia University College of Physicians and Surgeons, New York, NY.
  1. Address correspondence and reprint requests to Hannah Simonds, Division of Radiation Oncology, Tygerberg Hospital, Private Bag X1, Tygerberg 7505, South Africa. E-mail hsimonds@googlemail.com.

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.

  • Cervical cancer
  • Human immunodeficiency virus
  • AIDS-defining malignancy
  • Radiation
  • Chemoradiation
  • Toxicity

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Footnotes

  • The project described was supported by Award No. D43CA153715 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

  • The authors declare no conflicts of interest.

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