Is there any correlation between HPV and early radioresponse before brachytherapy in cervix uteri carcinoma?
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ONCOLOGY IMAGING
Is there any correlation between HPV and early radioresponse before brachytherapy in cervix uteri carcinoma? Binnur Dönmez Yılmaz1 · Emre Uysal1 · Necla Gurdal1 · Alper Ozkan2 Received: 4 December 2019 / Accepted: 24 March 2020 © Italian Society of Medical Radiology 2020
Abstract Objective The prognostic effect of human papilloma virus (HPV) on early radioresponse before brachytherapy was evaluated in locally advanced cervix uteri carcinoma patients. Methods Between 2015 and 2018, 150 patients with locally advanced carcinoma of the cervix uteri from University of Health Sciences Okmeydani Training and Research Hospital and Istanbul Oncology Hospital underwent chemotherapy concomitant with external radiotherapy and brachytherapy after performing fluorodeoxyglucose positron emission tomography (FDG PET) and magnetic resonance imaging (MRI) for purposes of staging and treatment planning. The treatment results of patients analyzed retrospectively. Results The median age of 57 patients was 53 years, and the initial tumor volume was 27 cm3. The median follow-up period was 22 months. The median tumor volume after external radiotherapy was significantly higher in patients without local control than those who responded to external radiotherapy (p = 0.031). The mean tumor diameter and volume in all HPVnegative patients after external radiotherapy were significantly higher than those of HPV-positive patients (p = 0.011 and p = 0.046, respectively). In a group of patients with poor early responses, local disease control could not be achieved despite the use of recommended higher doses of brachytherapy. Conclusion We could not determine the correlation between HPV contamination and patients who had early response intervention. But residual tumor of more than 2 cm in diameter after external radiotherapy may be a predictor of failed local control and development of metastasis within a short time. Keywords Brachytherapy · HPV · Local advanced cervical cancer · Residual volume
Introduction According to Globocan 2018 data, cervical cancer is the fourth and most frequently seen cancer and cause of death among cancers observed in female population worldwide and ninth in Turkey [1, 2]. In more than 90% of the patients, it has been observed that limited socioeconomic conditions have a noticeable influence in the development of cervical carcinoma [3]. HPV is shown in the development of the disease, but its effect in response to treatment is not clear yet and testing of HPV is not routine in treatment. Fourteen of * Binnur Dönmez Yılmaz [email protected] 1
Department of Radiation Oncology, Okmeydani Training and Research Hospital, İstanbul, Turkey
Department of Radiation Oncology, İstanbul Oncology Hospital, İstanbul, Turkey
2
more than 100 types are identified as high risk and occur most frequently with HPV16, HPV18, HPV45 and HPV56 [4]. 70% of patients develop squamous cell cancer with HPV16 and cervical adenocarcinoma with poor prognosis with HPV18 [5, 6]. Again, poor prognosis is reported in
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