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Original research
Chemoradiation versus radiation alone in stage IIIB cervical cancer patients with or without human immunodeficiency virus
  1. Surbhi Grover1,2,
  2. Matthew S Ning3,
  3. Michelle Bale4,
  4. Katie E Lichter5,
  5. Sidrah Shah6,
  6. Memory Bvochora-Nsingo7,
  7. Sebathu Chiyapo7,
  8. Dawn Balang7,
  9. Gwendolyn J McGinnis8,
  10. Tlotlo Ralefala9,
  11. Thabo Moloi9,
  12. Rebecca Luckett10,
  13. Doreen Ramogola-Masire11,
  14. Erle S Robertson12 and
  15. Nicola M Zetola13
  1. 1Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2Oncology, University of Botswana, Gaborone, Botswana
  3. 3Radiation Oncology, University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, Texas, USA
  4. 4Radiation Oncology, The University of British Columbia, Vancouver, British Columbia, Canada
  5. 5Radiation Oncology, University of California San Francisco, San Francisco, California, USA
  6. 6The University of Texas Southwestern Medical Center, Dallas, Texas, USA
  7. 7Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
  8. 8Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  9. 9Princess Marina Hospital, Gaborone, Gaborone, Botswana
  10. 10Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  11. 11Obstetrics & Gynaecology - Faculty of Medicine, University of Botswana, Gaborone, Botswana
  12. 12Microbiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  13. 13Botswana-University of Pennsylvania Partnership, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Surbhi Grover, Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; surbhi.grover{at}pennmedicine.upenn.edu

Abstract

Objective Cervical cancer remains the most common cancer among women in sub-Saharan Africa and is also a leading cause of cancer related deaths among these women. The benefit of chemoradiation in comparison with radiation alone for patients with stage IIIB disease has not been evaluated prospectively in women living with human immunodeficiency virus (HIV). We assessed the survival of chemoradiation versus radiation alone among stage IIIB cervical cancer patients based on HIV status.

Methods Between February 2013 and June 2018, patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIIB cervical cancer with or without HIV and treated with chemoradiation or radiation alone, were prospectively enrolled in an observational cohort study. Overall survival was evaluated using the Kaplan–Meier method. Cox proportional hazards modeling was used to analyze associations with survival.

Results Among 187 patients, 63% (n=118) of women had co-infection with HIV, and 48% (n=69) received chemoradiation. Regardless of HIV status, patients who received chemoradiation had improved 2 year overall survival compared with those receiving radiation alone (59% vs 41%, p<0.01), even among women living with HIV (60% vs 38%, p=0.02). On multivariable Cox regression analysis, including all patients regardless of HIV status, 2 year overall survival was associated with receipt of chemoradiation (hazard ratio (HR) 0.63, p=0.04) and total radiation dose ≥80 Gy (HR 0.57, p=0.02). Among patients who received an adequate radiation dose of ≥80 Gy, adjusted overall survival rates were similar between chemoradiation versus radiation alone groups (HR 1.07; p=0.90). However, patients who received an inadequate radiation dose of <80 Gy, adjusted survival was significantly higher in chemoradiation versus radiation alone group (HR 0.45, p=0.01).

Conclusions Addition of chemotherapy to standard radiation improved overall survival, regardless of HIV status, and is even more essential in women who cannot receive full doses of radiation.

  • cervical cancer
  • radiation oncology
  • uterine cervical neoplasms

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author, SG. The data are not publicly available due to restrictions (eg, the data contain information that could compromise the privacy of research participants).

https://doi.org/10.1136/ijgc-2021-002601

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author, SG. The data are not publicly available due to restrictions (eg, the data contain information that could compromise the privacy of research participants).

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    Footnotes

    • Correction notice This article has been corrected since it was first published. The median follow-up time within the cohort was incorrectly reported. The correct follow-up time is 22 months (95% CI 8 to 34 months).

    • Contributors SG: study design, data analysis, interpretation, literature search, writing, and final review of the manuscript. MSN: data analysis, figures and tables, interpretation, writing, and final review of the manuscript. MB: data collection and data cleaning. KEL: literature search, writing, and review. SS: literature search, writing, and review. MB-N, SC, DB, GJM, TR, TM, RL, DR-M, ESR: data interpretation, editing, and final review of the manuscript. NMZ: study design, data analysis, interpretation, and final review of the manuscript.

    • Funding The Mentored Patient Oriented Career Research Development Award (1-K08CA230170-01A1), Department of Radiation Oncology, University of Pennsylvania, and Sub-Saharan African Collaborative HIV and Cancer Consortia-U54 (1U54 CA190158-01).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.