title: Completion of and early response to chemoradiation among human immunodeficiency virus (HIV)-positive and HIV-negative patients with locally advanced cervical carcinoma in South Africa.
abstract: BACKGROUND
  Very few published studies have dealt with the management of locally advanced cervix carcinoma among human immunodeficiency virus (HIV)-positive patients. The objective of this study was to compare the clinical characteristics, radiation and chemotherapy treatments, and outcomes in a cohort of HIV-positive and HIV-negative women with cervical cancer.
  
  
  METHODS
  The authors reviewed the charts of 59 HIV-positive patients and 324 HIV-negative patients who had stage IB1 to IIIB cervical carcinoma and who received radiation therapy. Demographic and clinical characteristics were compared at the time of diagnosis; and radiation doses, chemotherapy cycles, and responses were compared at the time of brachytherapy and at 6-week follow-up. Logistic regression models of response to treatment were developed.
  
  
  RESULTS
  Forty-nine HIV-positive patients (88.1%) but only 213 HIV-negative patients (65.7%) presented with stage IIIB disease (P = .009). Forty-seven HIV-positive patients (79.7%) and 291 HIV-negative patients (89.8%) completed the equivalent dose of 68 Grays (Gy) external-beam radiation and high-dose-rate brachytherapy. (P = .03). Of the 333 patients who commenced concurrent chemotherapy, 26 HIV-positive patients (53.1%) and 212 HIV-negative patients (74.6%) completed ≥4 weekly cycles of platinum-based treatment. Follow-up was censured at 6 weeks. In models that included age, disease stage, HIV status, and treatment, a poor response at 6 weeks was associated only with stage IIIB disease (odds ratio, 2.39; 95% confidence interval, 1.45-3.96) and receiving an equivalent radiation dose in 2-Gy fractions of <68 Gy (OR, 3.14; 95% CI, 1.24-7.94).
  
  
  CONCLUSIONS
  HIV-positive patients fared worse than HIV-negative patients because of later presentation and a decreased likelihood of completing treatment. The current findings emphasize the importance of completing irradiation therapy. Further studies will address the association of these variables with survival.
authors.affiliation: Division of Radiation Oncology, Tygerberg Hospital/University of Stellenbosch, Tygerberg, South Africa. hsimonds@sun.ac.za
authors.forename: Hannah M
authors.initials: HM
authors.lastname: Simonds
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Naomi
authors.initials: N
authors.lastname: du Toit
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Judith S
authors.initials: JS
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy; D059248:Chemoradiotherapy / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D013019:South Africa; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000628:therapy* / Q000821:virology*; D028761:Withholding Treatment
references.citation: J Clin Oncol. 1999 May;17(5):1339-48
references.pmid: 10334517
references.citation: Br J Radiol. 1989 Jan;62(733):68-9
references.pmid: 2914194
references.citation: Clin Oncol (R Coll Radiol). 2007 Sep;19(7):542-50
references.pmid: 17624745
references.citation: Curr Opin Oncol. 2010 Sep;22(5):449-55
references.pmid: 20613518
references.citation: Am J Clin Oncol. 2011 Apr;34(2):135-9
references.pmid: 20523206
references.citation: J Obstet Gynaecol. 2005 Oct;25(7):706-10
references.pmid: 16263548
references.citation: J Clin Oncol. 2008 May 20;26(15):2550-7
references.pmid: 18427149
references.citation: Curr HIV Res. 2010 Oct;8(7):493-7
references.pmid: 20946095
references.citation: J Clin Oncol. 2004 Mar 1;22(5):872-80
references.pmid: 14990643
references.citation: Radiother Oncol. 2005 Jan;74(1):31-5
references.pmid: 15683666
references.citation: J Clin Oncol. 2008 Dec 10;26(35):5802-12
references.pmid: 19001332
references.citation: Int J Cancer. 2008 May 15;122(10):2260-5
references.pmid: 18241034
references.citation: Gynecol Oncol. 2006 Feb;100(2):405-11
references.pmid: 16274737
references.citation: J Clin Oncol. 2007 Jul 1;25(19):2804-10
references.pmid: 17502627
references.citation: N Engl J Med. 1999 Apr 15;340(15):1154-61
references.pmid: 10202166
references.citation: Int J Gynecol Cancer. 2011 Feb;21(2):363-6
references.pmid: 21270617
references.citation: Int J Gynecol Cancer. 2006 Jul-Aug;16(4):1614-9
references.pmid: 16884375
references.citation: Int J Radiat Oncol Biol Phys. 2000 Oct 1;48(3):779-90
references.pmid: 11020575
references.citation: Int J Radiat Oncol Biol Phys. 2000 Jan 15;46(2):507-13
references.pmid: 10661360