Undetected human papillomavirus DNA and uterine cervical carcinoma: Association with cancer recurrence.
BACKGROUND
The time course of human papillomavirus (HPV) DNA clearance was studied in patients with carcinoma of the cervix during follow-up after primary radical radiotherapy (RT). This study investigated the relationship between timing of HPV clearance and RT effectiveness.


METHODS
A total of 71 consecutive patients who were treated for cervical cancer with primary radical radiotherapy and high-dose rate intracavitary brachytherapy with or without chemotherapy were enrolled in the study. Samples for HPV DNA examination were taken before (1) treatment, (2) every brachytherapy, and (3) every follow-up examination. The times when HPV DNA was undetected were analyzed for association with recurrence-free survival.


RESULTS
HPV DNA was not detected in 13 patients (18 %) before RT. Of the 58 patients with HPV DNA detected before treatment, HPV DNA was not detected in 34 % during treatment and in 66 % after the treatment. Within 6 months after RT, HPV DNA was detected in 0 % of all patients. The patients were followed up for a median period of 43 months (range 7-70 months). In all, 20 patients were found to develop recurrence. The 3-year cumulative disease-free survival (DFS) rate was 71 ・} 5.4 % for all 71 patients. In multivariate analysis, DFS was significantly associated with HPV (detected vs. not detected) with a hazard ratio of 0.07 (95 % confidence interval 0.008-0.6, p = 0.009).


CONCLUSIONS
In this study, patients in whom HPV was not detected had the worst prognosis. Six months after RT, HPV DNA was detected in 0 % of the patients. Patients in whom HPV DNA could not be detected before treatment need careful follow-up for recurrence and may be considered for additional, or alternative treatment.
Kae
K
Okuma
Hideomi
H
Yamashita
Terufumi
T
Yokoyama
Keiichi
K
Nakagawa
Kei
K
Kawana
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D001918:Brachytherapy; D018196:Carcinoma, Adenosquamous / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D015344:DNA Probes, HPV / Q000032:analysis*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D019233:Retreatment; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*
D015344:DNA Probes, HPV