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Outcomes after Radiation Therapy for HIV Positive Patients with Invasive Cervical Cancer

机译：HIV阳性浸润性宫颈癌放射治疗后的结果

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Objective: To assess tolerance, local control, and survival outcomes for HIV (human immunodeficiency virus) positive patients with locally advanced cervical cancer (CC) treated with external beam radiation therapy (EBRT) and/or brachytherapy from an Assistance Publique - H?pitaux de Paris (APHP) retrospective cohort. Methods: Between 2000 and 2014, 28 HIV positive patients presenting with a non-metastatic CC were treated in one of the five APHP radiation therapy centers. Fifteen patients (54%) underwent primary surgery. Twenty-four patients (88%) received EBRT, with concurrent chemotherapy in 22 cases, and 68% received brachytherapy. Results: The median follow-up was 58 months. At 5 years, local control (LCR) and overall survival rates (OS) were 56% and 46.5% respectively. A grade 3-4 acute toxicity (mainly hematological toxicity) was reported in 18 patients (64%). In univariate analysis, total irradiation dose (p=0.03) and cisplatin-based chemotherapy (p=0.005) were predictive of acute toxicity. A grade 3-4 late toxicity (mainly gastro-intestinal and renal) was observed in 7 patients (25%). In univariate analysis, HIV stage at diagnosis (p=0.02) and an initial CD4 count &200/mm3 (p=0.03) were predictive factors of late toxicity. Conclusion: In this study including HIV positive patients with CC, local control and overall survival rates seemed to be lower than those reported in the literature for non-HIV patients. We also reported an increase in acute and late toxicity, mainly hematological, underlying the fundamental role of immunosuppression in tolerance to radiation therapy.
机译：目的：评估通过外照射疗法（EBRT）和/或近距离放射疗法（通过Assistance Publique-H？pitaux治疗）的HIV（人类免疫缺陷病毒）阳性的局部晚期宫颈癌（CC）阳性患者的耐受性，局部控制和生存结果巴黎（APHP）回顾性队列。方法：从2000年到2014年，在五个APHP放射治疗中心之一对28例具有非转移性CC的HIV阳性患者进行了治疗。 15名患者（54％）接受了初次手术。 24例患者（88％）接受EBRT，同时进行化疗22例，68％接受近距离放射治疗。结果：中位随访时间为58个月。在5年时，局部控制（LCR）和总生存率（OS）分别为56％和46.5％。 18例患者（64％）报告了3-4级急性毒性（主要是血液学毒性）。在单变量分析中，总照射剂量（p = 0.03）和基于顺铂的化疗（p = 0.005）可预测急性毒性。在7例患者（25％）中观察到了3-4级晚期毒性（主要是胃肠道和肾脏）。在单变量分析中，诊断时的HIV分期（p ＝ 0.02）和初始CD4计数＜200 / mm 3（p ＝ 0.03）是晚期毒性的预测因素。结论：在这项包括CC阳性HIV阳性患者的研究中，局部控制和总体生存率似乎低于非HIV患者的文献报道。我们还报道了急性和晚期毒性（主要是血液学毒性）的增加，这是免疫抑制在放射治疗耐受性中的基本作用。

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