Hannah M Simonds1, Matthys H Botha2, Alfred I Neugut3, Frederick H Van Der Merwe2, Judith S Jacobson4. 1. Division of Clinical and Radiation Oncology, Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Tygerberg Academic Hospital, South Africa. Electronic address: hsimonds@sun.ac.za. 2. Department of Obstetrics and Gynecology, Unit for Gynaecological Oncology, Stellenbosch University, Tygerberg Academic Hospital, South Africa. 3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Centre, Columbia University, New York, NY, United States of America; Division of Oncology, Columbia University College of Physicians and Surgeons, New York, NY, United States of America. 4. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Centre, Columbia University, New York, NY, United States of America.
Abstract
OBJECTIVES: In South Africa, where HIV prevalence among adults is 18.9%, cervical carcinoma is the second most common malignancy in women. However, oncology services are considerably more accessible in South Africa than in many neighbouring countries. This study reports five-year overall survival in a cohort of HIV-positive and -negative cervix carcinoma patients undergoing primary radiotherapy at a single institution in South Africa. METHODS: Prospective cohort study of all locally advanced cervix carcinoma patients referred for radiotherapy (EBRT) from July 2007 to November 2011. Overall survival (OS) was the primary end-point. RESULTS: A total of 492 patients commenced treatment with radical intent, including 71 HIV-positive patients (14.4%) and 421 HIV-negative patients (85.6%). Of the 433 who were prescribed standard fractionation EBRT, 384 were prescribed concurrent platinum-based chemotherapy (88.7%). Fewer HIV-positive than HIV-negative patients (58.5% vs. 76.1%; p = 0.007) completed ≥4 cycles. The OS of HIV-negative patients was 49.5% (95%CI; 44.6%-54.4%) at 5 years. The OS of HIV-positive patients was significantly lower, 35.9% (95% CI; 23.9%-48.0%) at 5 years (p = 0.002). In our Cox models, factors affecting outcome were HIV infection, stage IIIB disease, presence of hydronephrosis, and delivery of concurrent chemotherapy. CONCLUSION: In our large cohort, HIV-positive patients had poorer survival than HIV-negative patients, however nearly 40% survived 5 years, justifying provision of the best standard of care to HIV-positive patients with cervical carcinoma.
OBJECTIVES: In South Africa, where HIV prevalence among adults is 18.9%, cervical carcinoma is the second most common malignancy in women. However, oncology services are considerably more accessible in South Africa than in many neighbouring countries. This study reports five-year overall survival in a cohort of HIV-positive and -negative cervix carcinomapatients undergoing primary radiotherapy at a single institution in South Africa. METHODS: Prospective cohort study of all locally advanced cervix carcinomapatients referred for radiotherapy (EBRT) from July 2007 to November 2011. Overall survival (OS) was the primary end-point. RESULTS: A total of 492 patients commenced treatment with radical intent, including 71 HIV-positive patients (14.4%) and 421 HIV-negative patients (85.6%). Of the 433 who were prescribed standard fractionation EBRT, 384 were prescribed concurrent platinum-based chemotherapy (88.7%). Fewer HIV-positive than HIV-negative patients (58.5% vs. 76.1%; p = 0.007) completed ≥4 cycles. The OS of HIV-negative patients was 49.5% (95%CI; 44.6%-54.4%) at 5 years. The OS of HIV-positive patients was significantly lower, 35.9% (95% CI; 23.9%-48.0%) at 5 years (p = 0.002). In our Cox models, factors affecting outcome were HIV infection, stage IIIB disease, presence of hydronephrosis, and delivery of concurrent chemotherapy. CONCLUSION: In our large cohort, HIV-positive patients had poorer survival than HIV-negative patients, however nearly 40% survived 5 years, justifying provision of the best standard of care to HIV-positive patients with cervical carcinoma.
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