Our data suggest that HPV viral load is a strong independent prognostic factor for DFS. HPV type 18 showed a significant relationship with poor radiotherapy outcome in univariate analysis, but not in multivariate analysis.

Human papillomavirus (HPV) DNA is considered as a hallmark of cervical cancer. We investigated whether persistent HPV DNA at the cervix is associated with local recurrence after radiotherapy in patients with locally advanced cervical cancer. A total of 156 patients with HPV-positive cervical cancer (International Federation of Gynecology and Obstetrics stage IB-IVB) treated with radiotherapy between July 2003 and December 2006 were analyzed. HPV DNA was measured prior to radiotherapy and after completion of radiotherapy. The results of HPV DNA test at postradiotherapy 1, 3, 6 and 12 months were analyzed individually for association with local recurrence-free survival (LRFS). In addition, the result of any last follow-up HPV test within 24 months postradiotherapy was defined as the overall status of HPV at 24 months and was also analyzed for association with LRFS. HPV DNA was cleared in 127 patients (81.4%) and persistent in 29 patients (18.6%) by 24 months. In 18 patients with local recurrences, 14 patients (78%) showed positive HPV tests at 1-3 months. Among the various time points analyzed, a positive HPV test at 3 months was the most accurate predictor of local recurrence. Multivariate analysis indicated that overall status of HPV at 24 months, low HPV viral load and histologic grade as being significantly related to poor LRFS. In HPV-positive cervical carcinoma treated primarily with radiotherapy, persistent HPV DNA within 24 months after treatment indicates a high risk of local recurrence. Diagnostic accuracy of HPV test was highest at 3 months.Cervical cancer is a significant health problem worldwide, ranking second highest in cancer incidence and fourth highest in site-specific cause of cancer death in women.1,2 While concurrent chemoradiotherapy is the main treatment modality for locally advanced cervical cancer, treatment failure in the central pelvis occurs in approximately 20-25% of patients. 3,4 Cytological tests are commonly inaccurate in detecting locally persistent or recurrent disease because the effect of radiation on the cells may result in ambiguous cell morphology in the early postradiotherapy period.5 Because positive high-risk human papillomavirus (HPV) DNA is considered as an important tool in the diagnosis of both preinvasive and invasive cervical cancer, the usefulness of the HPV test has often also been considered as a method of post-treatment surveillance. Previous studies have examined the effectiveness of the HPV DNA test as a clinically useful marker for detecting residual disease or recurrence after conservative surgical procedures for cervical intraepithelial neoplasia 6-8 and also after radiotherapy. [9][10][11][12] In terms of radiotherapy outcome, several past studies showed that HPV persistence is associated with high rates of local recurrence and poor overall survival in patients with cervical cancer. 10,11 However, the status of HPV DNA was only examined at a single time point after radiotherapy in those studies, and hence, the pattern of HPV clearance after radiotherapy and...