The clinical application value of dynamic monitoring of HPV ctDNA in concurrent chemoradiotherapy for locally advanced cervical cancer

The treatment principle for locally advanced cervical cancer is concurrent chemoradiotherapy (CCRT). However, local recurrence or distant metastasis may still occur after the completion of CCRT. Currently, there is no effective method to monitor the efficacy of CCRT and predict prognosis. This study aims to predict the therapeutic efficacy and prognosis by dynamically monitoring human papillomavirus (HPV) circulating tumor DNA (HPV ctDNA) levels. We enrolled 31 patients with locally advanced cervical cancer and used the HPV-Seq (14 subtypes) to quantify HPV genotype-specific DNA in plasma and tissues before and during CCRT, and in the post-treatment plasma. Regular imaging was performed to evaluate tumor regression. HPV reads in plasma and tissues decreased significantly during treatment (p < 0.05). Higher HPV ctDNA levels were associated with poorer treatment outcomes (p < 0.05). In univariate and multivariate analyzes, dynamic changes in plasma HPV ctDNA were an independent factor for predicting early treatment outcome. These findings indicate that longitudinal HPV ctDNA monitoring reflects the efficacy of CCRT in locally advanced cervical cancer and provides a basis for earlier identification of candidates for post-CCRT treatment intensive and prognostic stratification.