ObjectiveCervical cancer remains the most common cancer among women in sub-Saharan Africa and is also a leading cause of cancer related deaths among these women. The benefit of chemoradiation in comparison with radiation alone for patients with stage IIIB disease has not been evaluated prospectively in women living with human immunodeficiency virus (HIV). We assessed the survival of chemoradiation versus radiation alone among stage IIIB cervical cancer patients based on HIV status.MethodsBetween February 2013 and June 2018, patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIIB cervical cancer with or without HIV and treated with chemoradiation or radiation alone, were prospectively enrolled in an observational cohort study. Overall survival was evaluated using the Kaplan–Meier method. Cox proportional hazards modeling was used to analyze associations with survival.ResultsAmong 187 patients, 63% (n=118) of women had co-infection with HIV, and 48% (n=69) received chemoradiation. Regardless of HIV status, patients who received chemoradiation had improved 2 year overall survival compared with those receiving radiation alone (59% vs 41%, p<0.01), even among women living with HIV (60% vs 38%, p=0.02). On multivariable Cox regression analysis, including all patients regardless of HIV status, 2 year overall survival was associated with receipt of chemoradiation (hazard ratio (HR) 0.63, p=0.04) and total radiation dose ≥80 Gy (HR 0.57, p=0.02). Among patients who received an adequate radiation dose of ≥80 Gy, adjusted overall survival rates were similar between chemoradiation versus radiation alone groups (HR 1.07; p=0.90). However, patients who received an inadequate radiation dose of <80 Gy, adjusted survival was significantly higher in chemoradiation versus radiation alone group (HR 0.45, p=0.01).ConclusionsAddition of chemotherapy to standard radiation improved overall survival, regardless of HIV status, and is even more essential in women who cannot receive full doses of radiation.

No abstract

The dose of residual tumor and metastatic lymph nodes were all boosted to 64-82Gy (EQD2, a/b Z 10) after pelvic irradiation in 50Gy/25F. The boost techniques were three-dimensional conformal radiotherapy, intensity-modulated radiotherapy or brachytherapy. Cisplatin-based chemotherapy was given concurrent with radiotherapy. Kaplan-Meier survival curve was used to analyze the outcomes of the patients. Results: The median age of all patients was 51 years (range: 26-75 y). Median time from surgery to recurrence was 19.2 months (range：0.6-131.8 months). 91 patients had squamous cell carcinoma (95.8%), and 4 patients had adenocarcinoma (4.2%). The maximum diameter of residual mass with3cm occurred in 51 cases (53.7%). There were 26 cases (27.4%) with lymph node metastasis and 10 cases (10.5%) with adjacent organ invasion. 80 patients (84.2%) had received total radiation dose of 64-70Gy (EQD2, a/b Z 10) for recurrent lesions, while 15 patients (15.8%) got 71-82Gy. 75 patients (78.9%) received concurrent chemotherapy. The median follow-up time was 32.7 months (range: 3.4-100.6 months). 13 patients died during follow-up. Kaplan-Meier survival curve analysis showed that the 3-year overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and local control (LC) were 87.5%, 84.6%, 84.8%, and 92.3%, respectively. 3-year OS for patients with vs without adjacent organ invasion was 58.7% and 94.8%, respectively (P < 0.001). 3-year OS for patients with or without lymph node metastasis was 50.5% and 91.8%, respectively (P Z 0.007). 3-year OS for patients with mass 3cm or < 3cm was 80.5% and 95.4%, respectively (P Z 0.018). The higher radiotherapy dose did not improve the local control rate. And the 3-year local control rate (LC) with total irradiation dose of 64-70Gy and 71-82Gy was similar 92.3% (p Z 0.913). The number of patients with grade 3 or 4 myelosuppression during treatment was 40 cases (42.1%), and grade 3 or 4 gastrointestinal toxicity was 1 case (1.1%). There was no grade 3 or 4 late complication, according to RTOG toxicity grading. Conclusion: Salvage concurrent chemoradiotherapy for patients with local recurrence after radical hysterectomy showed favorable clinical outcomes without severe complications.