Characterizing trimodal therapy outcomes by HIV status in early-stage cervical cancer: a retrospective cohort study from a Kenyan tertiary center

Abstract

Background: Adjuvant concurrent chemoradiotherapy following radical hysterectomy is the cornerstone of curative-intent treatment for early-stage cervical cancer. However, among people living with Human Immunodeficiency Virus (PLWHIV) and cervical cancer, the interplay of treatment toxicity, immunosuppression and systemic health barriers presents a compounded clinical challenge. Evidence on how HIV infection influences baseline clinical patterns and prognosis following standard multimodal therapy remains poorly characterized. Methods: We conducted a descriptive retrospective cohort review of women with FIGO 2018 stage IA–IIA cervical cancer who had completed curative- intent trimodal therapy (adjuvant pelvic external-beam radiotherapy (45–50.4 Gy), weekly cisplatin (40 mg/m²), and brachytherapy following radical hysterectomy (type II/III) with pelvic lymphadenectomy) between 2014 and 2023, at a tertiary referral hospital in Kenya. The baseline clinicopathological characteristics, treatment-related toxicities, 3-year disease-free survival (DFS), and 5-year overall survival (OS) were described. Results were ACCEPTED MANUSCRIPTARTICLE IN PRESSARTICLE IN PRESS stratified by HIV status. Survival analysis was conducted using Kaplan-Meier estimates and log-rank tests. Results: Over the 10-year study period, 275 patients with cervical cancer underwent radical hysterectomy with bilateral pelvic lymphadenectomy. Of 62 patients meeting criteria for adjuvant therapy (17 PLWHIV, 45 HIV- negative), 38 (61.3%) completed trimodal therapy. This corresponded to a completion rate of 76.5% (13/17) among PLWHIV versus 55.6% (25/45) among HIV-negative patients. Baseline clinicopathological profiles, including age, performance status, and histology (squamous cell carcinoma: 100% versus 88.0%) did not differ substantially between groups. Positive lymph nodes were the most common high-risk feature (53.8% versus 40.0%), and lymphovascular space invasion (LVSI) was the predominant intermediate-risk feature (69.2% versus 40.0%). Median time from surgery to adjuvant therapy initiation was 77.5 days (IQR 42–210). Lymphedema (21.1%) and bladder dysfunction (18.4%) were the frequently reported any-grade chronic toxicities. overall. Myelosuppression occurred in 23.1% versus 4.0%. The 3- year DFS was 53.8% among PLWHIV and 77.6% among HIV-negative patients (log-rank p = 0.14); median OS was 14.5 months versus 21.1 months (log-rank p = 0.12). Five-year survival estimates were not attainable for PLWHIV due to early recurrence and mortality. Conclusion: Despite comparable baseline characteristics, PLWHIV showed a nonsignificant trend toward greater treatment-related toxicity and reduced survival following trimodal therapy for early-stage cervical cancer. These ACCEPTED MANUSCRIPTARTICLE IN PRESSARTICLE IN PRESS findings underscore the importance of regional strengthening of HIV- oncology integrated services and generating, prospective research on optimum management strategies for this vulnerable cohort.