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Session Item

Saturday
August 28
18:00 - 19:00
N101-102
Poster Awards Ceremony
Jenny Bertholet, Switzerland;
Sophie Perryck, Switzerland
Presentation of the ESTRO Best Clinical, Physics and RTT Poster Awards and the CTRO, PHIRO, TIPSRO Young Investigators Awards.
Plenary session
Treatment toxicities of cervical cancer with or without HIV infection in Botswana 2013-2020
Shawna Tuli, USA
PO-1315

Abstract

Treatment toxicities of cervical cancer with or without HIV infection in Botswana 2013-2020
Authors:

Shawna Tuli1, Jessica George1, Barati Monare2, Memory Bvochora-Nsingo3, Katie Lichter4, Sebathu Chiyapo5, Dawn Balang3, Lisa Bazzett-Matabele6, Sanghyuk Shin7, Nicola Zetola8, Surbhi Grover9

1University of California, Irvine, Donald Bren School of Information and Computer Sciences, Irvine, USA; 2Botswana-University of Pennsylvania Partnership, Department of Radiation Oncology, Gaborone, Botswana; 3Gaborone Private Hospital, Department of Oncology, Gaborone, Botswana; 4University of California, San Francisco, Department of Radiation Oncology, San Francisco, USA; 5Princess Marina Hospital, Oncology Department, Gaborone, Botswana; 6University of Botswana School of Medicine, Department Obstetrics and Gynecology, Gaborone, Botswana; 7University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, USA; 8University of Pennsylvania School of Medicine, Department of Radiation Oncology, Philadelphia, USA; 9University of Pennsylvania Perelman School of Medicine, Department of Radiation Oncology, Philadelphia, USA

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Purpose or Objective

To examine factors associated with treatment toxicities for cervical cancer patients, with/without HIV infection, who initiated radiation therapy (RT) or chemoradiation therapy (CRT) in a limited-resource setting.

Material and Methods

Between April 2013 and November 2020, women with locally advanced cervical cancer, with/without HIV infection, initiating RT/CRT in Botswana were prospectively enrolled in an observational cohort study. We evaluated treatment received and the following grade 2 or higher (grade ≥ 2) toxicities during treatment: renal, anemia, neutrophil count, white blood cell count (WBC), albumin, GI, GU, vaginal/pelvic, and dermatitis. Association of antiretroviral therapies (ART) with toxicities were analyzed using logistic regression modeling.

Results

Of 1,034 women treated for cervical cancer, we included the 952 women treated with RT/CRT. Of those, 69% of patients were HIV-infected with median CD4 count cells/mm³ of 420,14% had detectable viral load, 94% were on ARTs. There was no difference in treatment received in the HIV-infected vs. uninfected groups in terms of RT dose and chemotherapy cycles.57% patients initiated curative RT/CRT. Grade ≥ 2 toxicities were as follows: 11% (n=52/459) renal; 48% (n=222/459) anemia; 32% (n=145/459) with neutrophil count; 64% (n=294/458) WBC; 28% (n=87/308) albumin; 5% (n=20/437) GI; 1% (n=3/411) GU; 11% (n=48/425) vaginal/pelvic; 48% (n=204/421) dermatitis. Significant differences in toxicities grade ≥ 2 were observed by HIV status for anemia (58% in HIV-infected vs. 14% in HIV-uninfected, p=0.005), neutrophil count (75% in HIV-infected vs. 22% in HIV-uninfected, p=0.054), and WBC (71% in HIV-infected vs. 22% in HIV-uninfected, p=0.036). Rates of the following grade ≥ 2 toxicities were different between patients receiving CRT vs. RT alone: renal (71% in CRT vs. 31% in RT, p=0.026); anemia (73% in CRT vs. 26% in RT, p<0.001); neutrophil count (98% in CRT vs. 3% in RT, p<0.001); WBC (94% in CRT vs. 6% in RT, p<0.001); albumin (21% in CRT vs. 47% in RT, p<0.001). In HIV-infected, associations with toxicities grade ≥ 2 were observed between renal and receipt of tenofovir (OR=2.43, p=0.018); neutrophil count and receipt of azidothymidine (AZT) (OR=2.60, p=0.0001); WBC and receipt of AZT (OR=2.04, p=0.005); GI and protease inhibitors (OR=12.197, p=0.042).

Conclusion

In this cohort of women with locally advanced cervical cancer in Botswana, who predominantly have well-managed HIV infection, HIV-infected/uninfected received similar treatments. Patients with/without HIV infection tolerated treatment similarly except for differences in bone marrow toxicities. Patients receiving CRT were more likely to have renal and bone marrow toxicities compared to patients receiving RT alone.