title: Impact of viral E2-gene status on outcome after radiotherapy for patients with human papillomavirus 16-positive cancer of the uterine cervix.
abstract: OBJECTIVE
  Integration of high-risk papillomavirus DNA has been considered an important step in oncogenic progression to cervical carcinoma. Disruption of the human papillomavirus (HPV) genome within the E2 gene is frequently a consequence. This study investigated the influence of episomal viral DNA on outcome in patients with advanced cervical cancer treated with primary radiotherapy.
  
  
  METHODS
  Paraffin-embedded biopsies of 82 women with locally advanced cervical cancer could be analyzed for HPV infection by multiplex polymerase chain reaction (PCR) by use of SPF1/2 primers. E2-gene intactness of HPV-16-positive samples was analyzed in 3 separate amplification reactions by use of the E2A, E2B, E2C primers. Statistical analyses (Kaplan-Meier method; log-rank test) were performed for overall survival (OS), disease-free survival (DFS), local progression-free survival (LPFS), and distant metastases-free survival (DMFS).
  
  
  RESULTS
  Sixty-one (75%) of 82 carcinomas were HPV positive, 44 of them for HPV-16 (72%). Seventeen of the 44 HPV-16-positive tumors (39%) had an intact E2 gene. Patients with a HPV-16-positive tumor and an intact E2 gene showed a trend for a better DFS (58% vs. 38%, p = 0.06) compared with those with a disrupted E2 gene. A nonsignificant difference occurred regarding OS (87% vs. 66%, p = 0.16) and DMFS (57% vs. 48%, p = 0.15).
  
  
  CONCLUSIONS
  E2-gene status may be a promising new target, but more studies are required to elucidate the effect of the viral E2 gene on outcome after radiotherapy in HPV-positive tumors.
authors: Department of Radiation Oncology and Radiotherapy, University of Heidelberg, Heidelberg, Germany. katja_Lindel@med.uni-heidelberg.de
authors: Katja
authors: K
authors: Lindel
authors: Ethel-Michele
authors: EM
authors: de Villiers
authors: Philipp
authors: P
authors: Burri
authors: Ueli
authors: U
authors: Studer
authors: Hans J
authors: HJ
authors: Altermatt
authors: Richard H
authors: RH
authors: Greiner
authors: Guenther
authors: G
authors: Gruber