Outcomes of Cervical Cancer in HIV-Positive Women Treated With Radiotherapy at a Tertiary Care Center in India.
Outcomes of Cervical Cancer in HIV-Positive Women Treated With Radiotherapy at a Tertiary Care Center in India.
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DOI：
10.1200/go.21.00312
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发表时间：
2022-03
影响因子：
4.5
通讯作者：
Mahantshetty, Umesh
中科院分区：
文献类型：
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作者：
Gurram, Lavanya;Mohanty, Samarpita;Chopra, Supriya;Grover, Surbhi;Engineer, Reena;Gupta, Sudeep;Ghosh, Jaya;Gulia, Seema;Sawant, Sheela;Daddi, Anuprita;Deodhar, Kedar;Menon, Santosh;Rekhi, Bharat;Shylasree, T. S.;Maheshwari, Amita;Mahantshetty, Umesh
在现代抗逆转录病毒治疗时代，关于感染艾滋病毒的妇女宫颈癌管理的数据有限。该研究旨在评估这些患者接受放射治疗的结果和毒性。印度一家三级医疗中心对2011年至2018年接受放射治疗的艾滋病毒阳性宫颈癌患者进行了回顾性分析。82例接受放射治疗的hiv阳性宫颈癌患者。他们的平均年龄是45岁。74例（90%）患者接受了治疗目的放疗，8例患者接受了姑息性放疗。治疗开始时的中位CD4计数为342个细胞/mm3（四分位数范围：241-531）。在计划进行最终放疗的患者中，52例（70%）患者计划同时使用顺铂，中位化疗周期为4个，81% （n = 60）患者接受近距离放疗。在接受近距离放疗的患者中，处方剂量中位数为80 Gy。77名患者完成了规定的治疗。在中位37个月的随访中，计划治愈意图的患者3年无病生存率为54%。在多变量分析中，治疗完成与有利的无病生存相关。5例（6.8%）患者出现III/IV级急性胃肠道毒性，而30%的患者出现III/IV级急性血液学毒性。所有患者均在良好的辅助护理下完成了放疗计划。对于感染艾滋病毒并伴有局部晚期宫颈癌的妇女，应计划进行标准的放化疗。我们的研究强调需要一个多学科团队对这些患者进行最佳管理，并提供强化的支持性护理，以确保完成计划治疗以获得更好的结果。
There are limited data on management of cervical cancer in women living with HIV in the modern antiretroviral therapy era. The study aimed to evaluate outcomes and toxicities of these patients treated with radiotherapy. A retrospective analysis of HIV-positive cervical cancer patients treated with radiotherapy between 2011 and 2018 was conducted at a tertiary care center in India. Eighty-two HIV-positive cervical cancer patients treated with radiotherapy were identified. Their median age was 45 years. Seventy-four (90%) patients received radiotherapy with curative-intent and eight patients received palliative radiotherapy. Median CD4 count at the start of treatment was 342 cells/mm3 (interquartile range: 241-531). Among patients planned for definitive radiotherapy, concurrent cisplatin was planned in 52 (70%) patients with a median of four chemotherapy cycles, and 81% (n = 60) patients received brachytherapy. Among patients who received brachytherapy, the median prescription dose was 80 Gy. Seventy-seven patients completed their prescribed treatment. At a median follow-up of 37 months, 3-year disease-free survival of patients planned with curative-intent was 54%. On multivariate analysis, treatment completion was associated with favorable disease-free survival. Grade III/IV acute gastrointestinal toxicity was seen in five (6.8%) patients, whereas 30% patients had grade III/IV acute hematologic toxicity. All these patients completed their planned radiotherapy with good supportive care. Standard treatment of chemoradiation should be planned in women living with HIV with well-managed HIV presenting with locally advanced cervical cancer. Our study highlights the need for optimal management of these patients by a multidisciplinary team with intensive supportive care to ensure completion of planned treatment to achieve better outcomes.