Five-year overall survival following chemoradiation among HIV-positive and HIV-negative patients with locally advanced cervical carcinoma in a South African cohort
| Autor: | Frederick H van der Merwe, M H Botha, Judith S. Jacobson, Hannah Simonds, Alfred I. Neugut |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Uterine Cervical Neoplasms HIV Infections Disease Malignancy 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine Prospective Studies 030212 general & internal medicine Prospective cohort study Aged Proportional Hazards Models Cervical cancer Chemotherapy business.industry Proportional hazards model Obstetrics and Gynecology Chemoradiotherapy Middle Aged medicine.disease CD4 Lymphocyte Count Radiation therapy Oncology 030220 oncology & carcinogenesis Cohort Female business |
| Zdroj: | Gynecologic Oncology. 151:215-220 |
| ISSN: | 0090-8258 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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