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Front. Oncol. | doi: 10.3389/fonc.2018.00276

Organ-specific Toxicities due to Radiation Therapy in Cancer Patients with or without HIV Infection: A Systematic Review of the Literature

 Melody J. Xu1, Alison Liewen2, Luca Valle3,  Adam Olson4, Nicola M. Zetola2 and  Surbhi Grover2*
  • 1University of California, San Francisco, United States
  • 2University of Pennsylvania, United States
  • 3University of California, Los Angeles, United States
  • 4Duke University, United States

BACKGROUND: To synthesize published literature on the association between human immunodeficiency virus (HIV) infection and radiation therapy (RT)-related toxicities.
METHODS: Two electronic databases, MEDLINE and Embase, were searched to identify studies published before November 2016 comparing RT-related toxicities between HIV-infected and HIV-uninfected patients receiving RT or chemoradiation therapy (CRT) for cancer. A qualitative synthesis of included articles and organ-specific toxicities was then performed.
RESULTS: Of the 21 studies included in this review, 15 reported on anal cancer treatment, three on cervical cancer, two on Kaposi sarcoma, and one on prostate cancer. Reports in the pre-antiretroviral therapy (ART) or early ART era tended to identify increased morbidity and mortality with HIV infection. However, modern series incorporating more concurrent chemotherapy, conformal RT techniques, and ART administration result in fewer studies reporting toxicity differences in patients treated for anal and cervical cancers. When statistically significant, HIV-infected patients had higher rates of gastrointestinal toxicity with anal cancer CRT (up to 50%) and higher rates of hematologic toxicity with cervical cancer CRT (up to 31%). Of the 17 studies reporting treatment outcomes, nine suggest HIV-infected patients may have reduced local control and/or survival rates.
CONCLUSIONS: Overall, RT is likely similarly tolerated between HIV-infected and HIV-uninfected patients, especially with modern RT techniques. HIV-infected patients should continue to receive established standard of care RT and CRT dosing.

Keywords: human immunodeficiency virus, Toxicity, Radiotherapy, non-AIDS defining cancer, Anal cancer, cervical cancer

Received: 07 May 2018; Accepted: 02 Jul 2018.

Edited by:

Sean P. Collins, School of Medicine, Georgetown University, United States

Reviewed by:

Alina M. Mihai, University of Toronto, Canada
John A. Vargo, West Virginia University Hospitals, United States  

Copyright: © 2018 Xu, Liewen, Valle, Olson, Zetola and Grover. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Surbhi Grover, University of Pennsylvania, Philadelphia, United States,