The Impact of HIV Status on Staging, Treatment and Outcomes in Locally Advanced Cervical Carcinoma
Project ended 31 March 2019
A/Prof Hannah Simonds
- Medical Imaging and Clinical Oncology/Radiation Oncology, Stellenbosch University/Tygerberg Hospital
Title of the project
The impact of HIV status on staging, treatment and outcomes in locally advanced cervical carcinoma.
The ideal staging techniques and treatment regimens for HIV-infected cervical carcinoma patients have yet to be established. Determination of best standard care is needed to ensure effective control of cervical carcinoma in this vulnerable and growing cohort of patients. Two concurrent studies will be performed. Study 1 is a retrospective data analysis on an existing cohort. Study 2 is a retrospective/ prospective descriptive analysis of imaging findings. Two previous studies related to the existing cohort have been published. Together these 4 studies will be submitted for a PhD in Radiotherapy and Isotopes at Stellenbosch University.
A study of nearly 500 patients with locally advanced cervix cancer found that with the best standard of care with radiotherapy and chemotherapy the chance of surviving five years was 50%. This is a similar finding when compared to many studies in developed and other developing countries. The chance of survival was linked to advanced disease, HIV positive status and not being able to receive chemotherapy. The reason those with HIV do not do as well as those who are HIV negative is unknown – it may be linked to complications of HIV or and effect of HIV leading to more aggressive cancers.
A study of nearly 300 patients with locally advanced cervix cancer looked at the additional use of highly advanced imaging with a PET-CT scan to look for spread of disease prior to radiotherapy. The results of the study showed that PET-CT scanning frequently picked up involved lymph glands not seen on ultrasound. This information lead to changes to a more appropriate treatment or radiation dose in nearly 50% of patients. HIV positive status did not influence the findings on PET-CT nor the change in the treatment decision.
Value of the project in the struggle against cancer
Overall these studies aimed to answer questions regarding the effect of concurrent HIV-positivity and locally advanced cervical carcinoma. The common outcome is that HIV-positivity should not hinder the use of advanced imaging techniques and best standard of care with chemoradiation. Patients must be established on cART and support from infectious disease colleagues is essential to ensure patients have a suppressed viral load and are compliant on therapy.
Thereafter the use of PET-CT for accurate staging is suitable for this population of patients and necessary to ensure the correct treatment plan is made. During treatment, due caution must be given to maintaining compliance on cART, prophylaxis with appropriate antibiotic cover and proactive management of haematological toxicities. Survival outcomes, though lover in HIV-positive patients, confirm that all patients with locally advanced cervical carcinoma should have equal access to appropriate oncological therapy.
- HIV status does not have an impact on positron emission tomography-computed tomography (PET-CT) findings or radiotherapy treatment recommendations in patients with locally advanced cervical cancer
- Five-year overall survival following chemoradiation among HIV-positive and HIV-negative patients with locally advanced cervical carcinoma in a South African cohort