Surbhi Grover1, Memory Bvochora-Nsingo2, Alyssa Yeager3, Sebathu Chiyapo4, Rohini Bhatia5, Emily MacDuffie6, Priya Puri3, Dawn Balang2, Sarah Ratcliffe7, Mohan Narasimhamurthy8, Elliphine Gwangwava2, Sylvia Tsietso2, Mukendi K A Kayembe9, Doreen Ramogola-Masire10, Scott Dryden-Peterson11, Umesh Mahantshetty12, Akila N Viswanathan13, Nicola M Zetola14, Lilie L Lin15. 1. Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana University of Pennsylvania Partnership, Gaborone, Botswana; Princess Marina Hospital, Gaborone, Botswana; School of Medicine, University of Botswana, Gaborone, Botswana. Electronic address: Surbhi.grover@uphs.upenn.edu. 2. Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana. 3. Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 4. Princess Marina Hospital, Gaborone, Botswana. 5. University of Rochester School of Medicine and Dentistry, Rochester, New York. 6. Warren Alpert Medical School of Brown University, Providence, Rhode Island. 7. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania. 8. Department of Pathology, University of Botswana, Gaborone, Botswana. 9. National Health Laboratories, Gaborone, Botswana. 10. Botswana University of Pennsylvania Partnership, Gaborone, Botswana; School of Medicine, University of Botswana, Gaborone, Botswana; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 11. Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Botswana Harvard AIDS Institute, Gaborone, Botswana; Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 12. Department of Radiation Oncology, TATA Memorial Hospital, Mumbai, India. 13. Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland. 14. Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana University of Pennsylvania Partnership, Gaborone, Botswana. 15. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
PURPOSE: To prospectively compare survival between human immunodeficiency virus (HIV)-infected versus HIV-uninfected cervical cancer patients who initiated curative chemoradiation therapy (CRT) in a limited-resource setting. METHODS AND MATERIALS: Women with locally advanced cervical cancer with or without HIV infection initiating radical CRT in Botswana were enrolled in a prospective, observational, cohort study from July 2013 through January 2015. RESULTS: Of 182 women treated for cervical cancer during the study period, 143 women initiating curative CRT were included in the study. Eighty-five percent of the participants (122 of 143) had stage II/III cervical cancer, and 67% (96 of 143) were HIV-infected. All HIV-infected patients were receiving antiretroviral therapy (ART) at the time of curative cervical cancer treatment initiation. We found no difference in toxicities between HIV-infected and HIV-uninfected women. The 2-year overall survival (OS) rates were 65% for HIV-infected women (95% confidence interval [CI] 54%-74%) and 66% for HIV-uninfected women (95% CI 49%-79%) (P = .70). Factors associated with better 2-year OS on multivariate analyses included baseline hemoglobin >10 g/dL (hazard ratio [HR] 0.37, 95% CI 0.19-0.72, P = .003), total radiation dose ≥75 Gy (HR 0.52, 95% CI 0.27-0.97, P = .04), and age <40 years versus 40-59 years (HR 2.17, 95% CI 1.05-4.47, P = .03). CONCLUSIONS: Human immunodeficiency virus status had no effect on 2-year OS or on acute toxicities in women with well-managed HIV infection who initiated curative CRT in Botswana. In our cohort, we found that baseline hemoglobin levels, total radiation dose, and age were associated with survival, regardless of HIV status.
PURPOSE: To prospectively compare survival between human immunodeficiency virus (HIV)-infected versus HIV-uninfected cervical cancerpatients who initiated curative chemoradiation therapy (CRT) in a limited-resource setting. METHODS AND MATERIALS: Women with locally advanced cervical cancer with or without HIV infection initiating radical CRT in Botswana were enrolled in a prospective, observational, cohort study from July 2013 through January 2015. RESULTS: Of 182 women treated for cervical cancer during the study period, 143 women initiating curative CRT were included in the study. Eighty-five percent of the participants (122 of 143) had stage II/III cervical cancer, and 67% (96 of 143) were HIV-infected. All HIV-infectedpatients were receiving antiretroviral therapy (ART) at the time of curative cervical cancer treatment initiation. We found no difference in toxicities between HIV-infected and HIV-uninfectedwomen. The 2-year overall survival (OS) rates were 65% for HIV-infectedwomen (95% confidence interval [CI] 54%-74%) and 66% for HIV-uninfectedwomen (95% CI 49%-79%) (P = .70). Factors associated with better 2-year OS on multivariate analyses included baseline hemoglobin >10 g/dL (hazard ratio [HR] 0.37, 95% CI 0.19-0.72, P = .003), total radiation dose ≥75 Gy (HR 0.52, 95% CI 0.27-0.97, P = .04), and age <40 years versus 40-59 years (HR 2.17, 95% CI 1.05-4.47, P = .03). CONCLUSIONS:Human immunodeficiency virus status had no effect on 2-year OS or on acute toxicities in women with well-managed HIV infection who initiated curative CRT in Botswana. In our cohort, we found that baseline hemoglobin levels, total radiation dose, and age were associated with survival, regardless of HIV status.
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