The Impact Of Human Papilloma Virus Genotype On Clinical Response To Chemoradiotherapy In Patients Of Carcinoma Cervix

Aim and Objective-Cervical cancer ranks as the fourth most common cancer and cause of cancer-related deaths in women worldwide. In India, it is the second most common cancer among women, with 123,907 new cases and 77,348 deaths reported in 2020, contributing significantly to global incidence and mortality rates.Global studies have consistently shown that over 99% of cervical cancer cases are associated with the presence of the Human Papillomavirus (HPV). This study was aimed to study the impact of HPV genotype on clinical response to chemoradiotherapy and to elucidate the correlation of HPV genotype in patients of carcinoma cervix with age, stage and histopathology. Materials and Methods:This study included 46 patients with biopsy-confirmed carcinoma cervix, who had an ECOG17 performance status of 0-2 and were classified as FIGO stages IIB to IIIC2. At baseline, patients underwent a comprehensive evaluation, including blood tests, CECT whole abdomen or CEMRI pelvis scans and a detailed clinical history and physical examination. Cervical swabs were also collected to assess HPV genotype, including the presence or absence of HPV and identification of 14 high-risk HPV genotype using Real-Time PCR kits. The treatment regimen consisted of external beam radiation therapy with concurrent chemotherapy, comprising weekly cisplatin injections at 40 mg/m², followed by brachytherapy. Following treatment, patients were followed up at first, third and sixth months with CECT whole abdomen or CE MRI pelvis scans, which were compared to baseline scans using RECIST criteria to assess treatment response, categorized as good or poor. Chi Square test of significance was used for all the calculations. Results- Among 46 patients, 45 (97.8%) were HPV-positive and 1 was HPV-negative(2.2%). Squamous cell carcinoma (SCC) was the predominant histology across all age groups.The treatment response to chemoradiotherapy was good in 37 patients (80.4%) and poor in 9 patients (19.6%), irrespective of HPV status. The difference in treatment response between HPV-positive and HPV-negative patients was not statistically significant (P = 0.546). Out of 46 patients, 31.1% had HPV 16 as a single genotype, 4.3% had HPV 18, and 41.3% had multiple genotypes including HPV 16 and 18. Additionally, 13% had single or multiple genotypes other than HPV 16 and 18, including HPV 33, 66, 56, and 58 and one patient negative for HPV. At a significance level of α=0.05, the null hypothesis cannot be rejected for HPV status (p=0.466 > 0.05). This suggests insufficient evidence to establish a significant association between treatment response and HPV status and warranting further investigation into its role in cervical carcinoma. Conclusion- This study highlights the importance of HPV status in predicting treatment response to chemoradiotherapy in cervical cancer. HPV-positive tumors showed better outcomes, but HPV genotype had no significant impact on treatment response. Further research is needed to confirm these findings and explore the role of HPV subtypes in cervical carcinoma