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Gynecol Oncol. 2018 Feb;148(2):299-304. doi: 10.1016/j.ygyno.2017.11.034. Epub 2017 Dec 6.

Impact of HPV 16/18 infection on clinical outcomes in locally advanced cervical cancers treated with radical radio (chemo) therapy - A prospective observational study.

Author information

1
Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India. Electronic address: drumeshm@gmail.com.
2
Department of Cancer Biology, ACTREC, Tata Memorial Centre, HBNI, Navi Mumbai, India.
3
Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India.
4
Department of Microbiology, ACTREC, Tata Memorial Centre, HBNI, Navi Mumbai, India.
5
Department of Biostatistics, ACTREC, Tata Memorial Centre, HBNI, Navi Mumbai, India.
6
Department of Pathology, Tata Memorial Hospital, HBNI, Mumbai, India.
7
Department of Gynaecologic Oncology, Tata Memorial Hospital, HBNI, Mumbai, India.
8
Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India.
9
Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India; Radiation Oncology, Apollo Hospital, CBD Belapur, India.

Abstract

OBJECTIVE:

With an aim to investigate the impact of Human Papilloma Virus (HPV) 16/18 infection on clinical outcomes in locally advanced cervical cancers treated with radical radio (chemo) therapy, we undertook this prospective study.

METHODS:

Between May 2010 and April 2012, 150 histologically proven cervical cancer patients treated with radio (chemo) therapy were accrued. Cervical biopsies/brushings were collected at pre-treatment, end of treatment and at 3 monthly intervals up to 24months. Quantitative estimation of HPV 16/18 was done using real-time polymerase chain reaction (RT-PCR) and correlated with various clinical end-points.

RESULTS:

Out of 150 patients accrued, 135 patients were considered for final analysis. Pre-treatment HPV16/18 DNA was detected in 126 (93%) patients, with HPV-16 present in 91%. The mean log (±SD) HPV-16 and HPV-18 viral load at pre-treatment was 4.76 (±2.5) and 0.14 (±2.1) copies/10ng of DNA, respectively. Though significant decline in viral load was observed on follow-ups (p<0.0001); by 9-month follow-up, 89 (66%) patients had persistence of HPV infection. Patients with persistent HPV 16/18 infection had a significantly higher overall and loco-regional relapses [44/89 (49%) and 29/89 (32%)] as compared to HPV clearance by 9months [12/43 (28%) and 5/43 (11%)] with p=0.024 and p=0.02, respectively. Also, persistent HPV infection by 24-month showed a significant impact on loco-regional control (LRC) and recurrence-free survival (RFS).

CONCLUSION:

In locally advanced cervical cancers treated with radical radio (chemo) therapy, persistent HPV 16/18 infection is significantly high in immediate post-treatment period and correlated with higher loco-regional, overall relapses and was also associated with early relapses.

KEYWORDS:

Cervical cancer; Human papilloma virus; Radio(chemo) therapy; Relapses

PMID:
29203175
DOI:
10.1016/j.ygyno.2017.11.034
[Indexed for MEDLINE]

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