| dc.description.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
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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
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findings underscore the importance of regional strengthening of HIV-
oncology integrated services and generating, prospective research on
optimum management strategies for this vulnerable cohort. |
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