5 - Pet-ct Findings in Hiv-positive and Negative Patients With Locally Advanced Cervical Cancer in a South African Cohort
Year: 2019
Type: other
Abstract: IntroductionPET-CT imaging is commonly used to identify nodal involvement in locally advanced cervical carcinoma, but its appropriateness for that purpose among HIV-positive patients has rarely been studied. We analyzed PET-CT findings and subsequent treatment prescribed in patients with locally advanced cervical carcinoma in Cape Town, South Africa.MethodsWe identified a cohort of consecutive cervical carcinoma patients FIGO Stage IIB to IIIB at our cancer centre who underwent a planning 18FDG PET-CT scan from January 2015 through December 2018. Demographics, PET-CT findings, and subsequent treatment prescribed were recorded. Patients were selected for PET-CT only if they had no signs of distant disease on staging chest X-ray or abdominal ultrasound; were deemed suitable for radical chemoradiation by the multi-disciplinary team; and had normal renal function. HIV-positive patients ideally had to have been established on continuous antiviral therapy (cART) for more than 3 months and to have a CD4 cell count above 150. Small cell and neuroendocrine carcinoma cases were excluded from the study. Differences in demographic and clinical measures between HIV-positive and HIV-negative patients were evaluated by means of t-tests for continuous variables and X2 tests for categorical variables.ResultsOver a 4-year period, 278 patients, 192 HIV-negative (69.1%) and 86 HIV-positive (30.9%), met the inclusion criteria. HIV-positive patients had a median CD4 count of 475 cells/u03bcl (IQR 307-612 cells/u03bcl). More than 80% of patients had pelvic nodal involvement, and more than 40% had uptake in common iliac and/or para-aortic nodes. Nodal involvement was not associated with HIV status. Fifty-four patients (19.4%) had at least one site of distant metastatic disease. Overall, 235 patients (84.5%) were upstaged following PET-CT staging scan. Upstaging was not associated with HIV status (HIV-negative 83.9% vs HIV-positive 87.2%; p=0.47). Ten patients who did not return for radiotherapy were excluded from the analysis, Following PET-CT scan, treatment intent changed for 124 patients (46.3%): 53.6% of HIV-positive patients and 42.9% of HIV-negative patients (p=0.11). ConclusionWe found no differences between HIV-positive or HIV-negative patients in nodal involvement or occult metastases, and PET-CT imaging did not lead to, or justify, treatment differences between the two groups. Future studies will evaluate survival and correlation of upstaging with outcome.
Authors: Hannah Simonds, Hennie Botha, Annare Ellmann, James Warwick, Alex Doyruter, Alfred Neugut, Haynes Van der Merwe, Judith Jacobson
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4206719445