Chemotherapy induced renal and haematological toxicities in patients with invasive cervical cancer undergoing concurrent chemo-radiation

Abstract

Cervical cancer is the most commonly diagnosed form of cancer in women of the developing world. Globally, the standardised treatment for women with invasive cervical cancer is concurrent chemo-radiation. Despite the survival benefit of concurrent chemo-radiation, there are concerns about associated toxicities and their harmful effects. Limited evidence shows the monitoring of the renal and haematological effects in invasive cervical cancer patients receiving concurrent chemo-radiation, compounded by women's biological vulnerability to human immunodeficiency virus (HIV), particularly in South Africa. In this prospective quantitative descriptive study, participants that presented for treatment were selected upon meeting the inclusion criteria. The study used a sample of 82 women, 32 (39%) of whom were HIV positive. Females between the ages of 21 and 75 years formed part of the study. All participants were undergoing concurrent chemo-radiation treatment at the Inkosi Albert Luthuli Central Hospital at the time of data collection. This study aimed to determine the renal and haematological toxicities associated with the chemotherapy component of concurrent chemo-radiation in patients with invasive cervical cancer, using renal and haematological biomarkers. The biomarkers, urea, creatinine and estimated glomerular filtration rate assessed renal toxicity. The full blood count biomarkers haemoglobin, white blood cells, platelets and absolute neutrophil count assessed haematological toxicity. The main finding was haematological toxicity in both HIV positive and HIV negative participants. No renal toxicity was found in this study among both the HIV positive and negative participants. Seventy (85%) of participants had stage II invasive cervical cancer. Ninety three percent of the cohort was diagnosed with invasive squamous cell carcinoma. The study found that the chemotherapy treatment completion rates for HIV negative and HIV positive participants were similar. Both groups were just as likely to complete the chemotherapy part of concurrent chemo-radiation. Based on the findings of this study, the same concurrent chemo-radiation protocol may be applied to both HIV negative and HIV positive women with invasive cervical cancer, however, further research using a larger population followed over a longer period is highly recommended.