HIV impact on acute morbidity and pelvic tumor control following radiotherapy for cervical cancer
Department of Human Anatomy and Obstetrics and Gynecology, University of Nairobi, P.O. Box 2631, KNH 00202, Nairobi, Kenya; Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya; Nairobi Oncology Center, Nairobi, Kenya; Radiotherapy Unit, Kenyatta National Hospital, Nairobi, Kenya; Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya; International Center for Reproductive Health, Ghent University, Ghent, Belgium
Objective. To determine the impact of HIV infection on acute morbidity and pelvic tumor control following external beam radiotherapy (EBRT) for cervical cancer. Method. 218 patients receiving EBRT who also had HIV testing after informed consent was obtained were evaluated. Acute treatment toxicity was documented weekly during treatment and 1 month post-EBRT. Pelvic tumor control was documented at 4 and 7 months post-EBRT. Clinicians were blinded for HIV results. Results. About 20% of the patients were HIV-positive. Overall, 53.4% of the patients had radiation-related acute toxicity (grade 3-4). HIV infection was associated with a 7-fold higher risk of multisystem toxicity: skin, gastrointestinal tract (GIT) and genitourinary tract (GUT) systems. It was also an independent risk factor for treatment interruptions (adjusted relative risk 2.2). About 19% of the patients had residual tumor at 4 and 7 months post-EBRT. HIV infection was independently and significantly associated with 6-fold higher risk of residual tumor post-EBRT. The hazard ratio of having residual tumor after initial EBRT was 3.1-times larger for HIV-positive than for HIV-negative patients (P = 0.014). Conclusion. HIV is associated with increased risk of multisystem radiation-related toxicity; treatment interruptions and pelvic failure (residual tumor) following EBRT. HIV infection is an adverse prognostic factor for outcome of cervical cancer treatment. © 2005 Elsevier Inc. All rights reserved.
acute toxicity; adult; Africa; aged; anemia; article; controlled study; external beam radiotherapy; female; follow up; gastrointestinal toxicity; human; Human immunodeficiency virus infection; human tissue; informed consent; major clinical study; morbidity; pelvis tumor; priority journal; radiation injury; radical hysterectomy; risk factor; skin toxicity; urogenital system; uterine cervix cancer; Adult; Aged; Aged, 80 and over; Female; HIV Infections; Humans; Middle Aged; Radiation Injuries; Uterine Cervical Neoplasms