Main Session
Sep 29
QP 06 - International/Global Oncology 1: Impact of Radiation Techniques and Health System Access in Cancer Mortality

1030 - The Impact of HIV Status on Vaginal Stenosis among Cervical Cancer Patients Receiving Radiotherapy in Low- And Middle-Income Countries: A Single Center Prospective Study

05:05pm - 05:10pm PT
Room 307/308

Presenter(s)

Samuel Franck Seppo, MD Headshot
Samuel Franck Seppo, MD - Henry Ford Health/Henry Ford Hospital, Detroit, MI

S. F. Seppo1, A. Mallum2, M. Tendwa3, M. Vorster4, E. C. Oboh5, D. Myagmarsuren6, A. R. Bhatnagar7, E. Czarnecki7, and J. Akudugu8; 1Henry Ford Cancer Institute, Detroit, MI, 2Walter Susilu University, Mthatha, South Africa, 3Global Health Catalyst, Boston, MA, 4University of KwaZulu-Natal, Durban, South Africa, 5George Washington University School of Medicine, Washington, DC, United States, 6Virginia Tech Carilion School of Medicine, Roanoke, VA, 7Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI, 8University of Stellenbosch, Cape Town, South Africa

Purpose/Objective(s):

Vaginal stenosis (VS) is a well-recognized late toxicity seen in cervical cancer patients treated with radiation therapy (RT). It contributes to significant sexual morbidity and impaired quality of life. The rate of VS is known to be associated with RT dose and technique used. However, the impact of HIV infection on VS particularly in LMICs with high burden of both cervical cancer and HIV remains unclear. This study aims to determine the incidence of VS in cervical cancer patients treated with RT and its association with HIV status.

Materials/Methods:

This was a single center prospective study including cervical cancer patients treated with definitive external beam radiotherapy (EBRT) and brachytherapy (BT) in Durban, South Africa, between March 2022 and March 2023. Ethical clearance was obtained from the institutional review board of the Hospital. Patients treated with palliative RT and those with follow up of less than 12-month after completion of treatment were excluded. Sociodemographic and clinical data were collected including age, stage of disease, HIV status, use of vaginal dilator and incidence of self-reported VS at 2 different time points (3 months and 12 months). All patients received counselling on vaginal dilator use post RT.

Results:

A total of 107 patients were enrolled with a median age of 36.4 years (range: 28.2 to 62.9 years). The majority of patients (72%) presented with stage IIB-IIIB disease. RT was delivered either as conventional fractionation (50 Gy in 25 fractions) or as hypofractionated approach (42.72 Gy in 16 fractions) because of patients’ logistic challenges. All patients received concurrent chemotherapy and brachy boost. HIV prevalence was 86% (92/107). The overall VS incidence was 30.8% at 3 months and 47.7% at 12 months. VS was significantly more common in HIV-positive patients compared to HIV-negative patients at both time points (3 months: 34.8% vs. 13.3%, p = 0.04; 12 months: 51.1% vs. 26.7%, p = 0.05). Among HIV-positive patients, those treated with conventional RT had a significantly higher VS incidence (72.3%) as compared to those receiving hypofractionated RT (60.5%), p = 0.032. None of the patients reported using the prescribed vaginal dilators post-treatment.

Conclusion:

Positive HIV status is associated with an increased incidence of vaginal stenosis in cervical cancer patients treated with RT in LMICs. Hypofractionated RT may be associated with reduced rate of vaginal stenosis, but a multi-institutional pooled analysis may be needed to further validate our results. Due to social and cultural barriers, these patients refrain from using vaginal dilators. These findings emphasize the need to raise awareness and implement interventions to mitigate this issue in high-risk populations.