HPV and radiosensitivity of cervical cancer: a narrative review

BACKGROUND AND OBJECTIVE: Cervical cancer (CC), the most common gynecological malignancy, is divided into two categories: human papillomavirus-related [HPV positive (HPV+)] and non-HPV-related [HPV negative (HPV−)]. Compared with HPV− CC, HPV+ CC has better radiosensitivity and prognosis. We conducted a literature search and summarized relevant studies to explore the detailed mechanisms by which HPV+ improves the prognosis of CC compared to HPV−. METHODS: PubMed was used to search the literature on human papillomavirus, cervical cancer, and radiotherapy up to June 2022. KEY CONTENT AND FINDINGS: Compared with HPV− CC, HPV+ CC has better radiotherapy outcomes and better prognosis. HPV improves the radiotherapy sensitivity of CC by inhibiting damaged DNA repair, increasing cell cycle arrest, reducing hypoxia, increasing cellular immune response, and other mechanisms. However, the effect of HPV on radiotherapy sensitivity of CC is not consistent and is affected by HPV type, viral load, and many other factors. Partial HPV+ CCs, due to hypoxia and other factors, are resistant to radiotherapy and have a poor prognosis. HPV− CC has poor radiotherapy sensitivity and poor prognosis. With the spread of the vaccine, HPV− CC will gradually increase, which is a cause for concern. CONCLUSIONS: The radiosensitivity was significantly increased in patients with HPV+ CC, compared to HPV− patients. HPV improves the radiotherapy sensitivity of cervical cancer through a number of pathways. Meanwhile, the relationship between HPV and radiotherapy sensitivity is influenced by a number of factors. Some HPV+ CCs showed radiotherapy resistance, and HPV− CCs deserve further attention.