Acute toxicity to radical combination treatment in human immunodeficiency virus-positive cervical cancer patients: Experience from a resource-constrained center

Abstract

Background and Purpose: To determine acute toxicity to radical combination treatment in invasive cervical cancer patients seropositive to human immunodeficiency virus (HIV). Subjects and Methods: This is a retrospective review of HIV-seropositive patients managed for invasive cervical cancer between January 2012 and December 2017 at the radiotherapy and oncology center of our institution. Patients' sociodemographics, disease characteristics, and acute treatment-induced toxicity were extracted from their clinical case notes and were studied. Results: A total of 83 confirmed HIV patients with histologically diagnosed invasive cervical cancer were studied. Their median age at presentation was 37.8 years. The most common presenting symptom of cervical cancer was copious foul-smelling vaginal discharge accounting for 39.8%. Sixty-three (85.6%) patients presented with Eastern Cooperative Oncology Group performance status of 0 and 2 and 74 (89.2%) patients presented with International Federation of Gynecologists and Obstetricians Stage 2B and above. Seventy-four (89.2%) patients had access to highly active antiretroviral therapy. Fifty-five (66.3%) patients were started on radical chemoradiation of which 28 (50.1%) completed prescribed external beam radiotherapy. Thirteen (15.7%) patients were treated symptomatically to control symptoms of cervical cancer. Concurrent chemoradiation appears to be poorly tolerated with 25 (71.4%) of the patients in this arm of treatment developing either Grade 3 or 4 toxicities. Grade 3 hematologic and gastrointestinal tract (GIT) toxicity was seen in 17.9% and 25% of the patients, respectively, while 21.4% of the patients presented with Grade 4 skin toxicity, leading to treatment delays and interruptions. There was excellent symptomatic relief in patients treated with palliative intent. Conclusions: Radiotherapy and chemotherapy are effective modalities of treatment in a selected group of these set of patients with good control of symptoms related to cervical cancer. Palliative radiotherapy is also effective in patients with poor performance status in relieving symptoms of cervical cancer. Further research needed to be done to identify the optimum management of these patients with radiotherapy and/or chemotherapy to reduce treatment-induced toxicity, thereby minimizing treatment interruptions and delays which ultimately will improve their overall outcome.