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HIV status does not have an impact on positron emission tomography-computed tomography (PET-CT) findings or radiotherapy treatment recommendations in patients with locally advanced cervical cancer
  1. Hannah Simonds1,2,
  2. Matthys Hendrik Botha2,3,
  3. Annare Ellmann2,4,
  4. James Warwick2,4,
  5. Alex Doruyter5,
  6. Alfred I Neugut6,7,
  7. Haynes Van Der Merwe2,3 and
  8. Judith S Jacobson6
  1. 1 Radiation Oncology, Stellenbosch University, Stellenbosch, South Africa
  2. 2 Tygerberg Hospital, Cape Town, South Africa
  3. 3 Gynaecological Oncology, Stellenbosch University, Stellenbosch, South Africa
  4. 4 Nuclear Medicine, Stellenbosch University, Stellenbosch, South Africa
  5. 5 Node for Infection Imaging, Central Analytical Facilities, Stellenbosch University, Stellenbosch, South Africa
  6. 6 Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
  7. 7 Herbert Irving Comprehensive Cancer Centre, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
  1. Correspondence to Dr Hannah Simonds, Radiation Oncology, Stellenbosch University, Stellenbosch, Western Cape 7505, South Africa; hsimonds{at}sun.ac.za

Abstract

Introduction Positron emission tomography-computed tomography (PET-CT) imaging is commonly used to identify nodal involvement in locally advanced cervical carcinoma, but its appropriateness for that purpose among HIV-positive patients has rarely been studied. We analyzed PET-CT findings and subsequent treatment prescribed in patients with locally advanced cervical carcinoma in Cape Town, South Africa.

Methods We identified a cohort of consecutive cervical carcinoma patients International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IIIB at our cancer center who underwent a planning 18-fluorodeoxyglucose (18FDG) PET-CT scan from January 2015 through December 2018. Demographics, PET-CT findings, and subsequent treatment prescribed were recorded. Patients were selected for PET-CT only if they had no signs of distant disease on staging chest X-ray or abdominal ultrasound; were deemed suitable for radical chemoradiation by the multi-disciplinary team; and had normal renal function. HIV-positive patients ideally had to have been established on continuous antiviral therapy for more than 3 months and to have a CD4 cell count above 150 cells/μL. Small cell and neuroendocrine carcinoma cases were excluded from the study. Differences in demographic and clinical measures between HIV-positive and HIV-negative patients were evaluated by means of t-tests for continuous variables and χ2 tests for categorical variables.

Results Over a 4 year period, 278 patients—192 HIV-negative (69.1%) and 86 HIV-positive (30.9%)—met the inclusion criteria. HIV-positive patients had a median CD4 count of 475 cells/µL (IQR 307–612 cells/µL). More than 80% of patients had pelvic nodal involvement, and more than 40% had uptake in common iliac and/or para-aortic nodes. Nodal involvement was not associated with HIV status. Fifty-four patients (19.4%) had at least one site of distant metastatic disease. Overall, 235 patients (84.5%) were upstaged following PET-CT staging scan. Upstaging was not associated with HIV status (HIV-negative 83.9% vs HIV-positive 87.2%; p=0.47). Ten patients who did not return for radiotherapy were excluded from the analysis. Following their PET-CT scan, treatment intent changed for 124 patients (46.3%): 53.6% of HIV-positive patients and 42.9% of HIV-negative patients (p=0.11).

Conclusion We found no differences between HIV-positive or HIV-negative patients in nodal involvement or occult metastases, and PET-CT imaging did not lead to, or justify, treatment differences between the two groups. Future studies will evaluate survival and correlation of upstaging with outcome.

  • cervical cancer
  • radiotherapy
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Footnotes

  • Contributors HS: study concept, design, planning, data collection, data analysis and interpretation, draft preparation and final manuscript approval. MHB: study concept, planning, data interpretation, final manuscript revision and approval. AE: study concept, planning, data interpretation, final manuscript revision and approval. JW: study concept, planning, data interpretation, final manuscript revision and approval. AD: study concept, planning, data interpretation, final manuscript revision and approval. AIN: study concept, final manuscript revision and approval. HVDM: study concept, final manuscript revision and approval. JSJ: study concept, design, planning, data analysis and interpretation, final manuscript revisions and approval.

  • Funding Supported with grant funding from CANSA (The Cancer Association of South Africa). Any opinion, findings and conclusions or recommendations expressed in this material are those of the author(s) and CANSA does not accept liability in regard thereto.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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