M.Med., Faculty of Health Sciences, University of the Witwatersrand, 2009 / Objectives
Cancer of the cervix is one of the commonest cancers in South African females. Up to
30% of patients are HIV positive. The addition of chemotherapy to radiotherapy has been
shown to significantly improve local control and survival and concurrent chemoradiation
is the standard treatment for locally advanced cancer of the cervix. There is very limited
literature available concerning the tolerance and efficacy of this treatment in HIV positive
patients. This study aims to assess the acute toxicity of combined modality treatment in
these patients. This study is part of a multicenter International Atomic Energy Agency
sponsored study.
Materials and methods
Patients with FIGO stage IB2 to IIIB (without hydronephrosis) cervical cancer and who are
HIV positive, were randomized to receive radiotherapy alone or chemo-radiation. All
patients received 46 Gy in 23 fractions external beam radiation and high-dose-ratei
brachytherapy 8 Gy x 3 fractions. Chemotherapy consisted of bolus Cisplatin 30mg/m2
weekly given concurrently with the radiotherapy. Acute treatment toxicity was documented
weekly during treatment.
Results
64 patients were recruited to the study. 31 patients were randomized to the chemoradiation
arm and 33 patients to the radiation alone arm. Of the 64 patients recruited to the study, 6 in
the chemoradiation arm and 5 in the radiation only arm did not receive any treatment and
were therefore not evaluated. Stage IIB was the most common stage. The mean CD4 count
was 410 in the chemoradiation arm vs. 358.4 in the radiation only arm at randomization. Only
6 patients were on antiretroviral therapy at start of treatment, 3 in each arm. The number of
chemotherapy cycles received by patients in the chemoradiation arm ranged between 0 and 5
cycles. A total of 96 chemotherapy cycles were administered, with a median of 4 cycles per
patient. Overall, at least 76% of patients received at least 4 cycles of chemotherapy. The full
five intended courses of cisplatin were administered in 10 (40%) patients. Chemotherapy was
not administered most commonly due to toxicity (renal, leucopaenia), other reasons being
logistical and non compliance. The principle major adverse effects observed were
leucopaenia and cutaneous reactions.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/7468 |
| Date | 24 November 2009 |
| Creators | Msadabwe, Susan Citonje |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
Page generated in 0.0019 seconds