Currently, there is a paucity of data evaluating post-treatment human papillomavirus (HPV) clearance in patients who receive definitive chemoradiotherapy (CRT) for the treatment of locally advanced cervical cancer and its correlation with oncological outcomes.
We included patients with histopathologically-confirmed locally advanced cervical cancer who were amenable to definitive CRT and brachytherapy. The subjects underwent a pretreatment liquid-based cytology to perform mRNA-based testing for HPV infection. We repeated the HPV testing 6 weeks after the patients completed their treatment. Response to treatment was evaluated with clinical examination, cervical cytology, and a contrasted pelvic MRI.
Over a 6-month period, 23 patients were included in our study. The mean age at diagnosis was 65 years. Regarding clinical stage (CS), 13% of cases were classified as CS IIA1 non-bulky disease, whereas 87% were classified as CS IB2 to IVB disease. HPV infection was reported in 87% of cases, from which 34% presented more than one HPV genotype. The most prevalent HPV genotype was 16 (48%), followed by 72 (13%) and 18 (9%). Sixteen patients completed the treatment protocol and underwent evaluation for clinical response and post-treatment HPV testing. A complete response (CR) was documented in 81% of cases. Of the sixteen evaluable patients, 13 were initially positive for HPV infection; viral clearance was documented in 8 cases (62%). From all patients who achieved HPV clearance, we documented CR in 54% of cases, whereas only 31% of patients who did not achieve HPV clearance presented a CR. After analysis, we did not find a statistically significant correlation between HPV clearance and CR. HPV clearance was neither correlated with the CS at diagnosis.
Despite the high rate of post-treatment HPV clearance reported among our patients with locally advanced cervical cancer, we found no correlation with achieving a CR. The role of HPV clearance in this setting needs to be further evaluated to determine its value in clinical response and other oncological outcomes like disease-free interval or overall survival.
The authors.
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All authors have declared no conflicts of interest.