The significance of pretreatment CD4 count on the outcome and treatment tolerance of HIV-positive patients with anal cancer.
OBJECTIVE
To assess the outcome and tolerance of HIV-positive patients with anal cancer to standard therapy based on their pretreatment CD4 count.


METHODS
Between 1991 and 1997, 17 HIV-positive patients with anal cancer and documented pretreatment CD4 counts were treated at the University of California, San Francisco or its affiliated hospitals with either concurrent chemotherapy and radiation or radiation alone. The outcome and complications of treatment were correlated with the patients' pretreatment CD4 count.


RESULTS
Disease for all 9 patients with pretreatment CD4 counts > or = 200 was controlled with chemoradiation. Although four required a treatment break of 2 weeks because of toxicity, none required hospitalization. Of the 8 patients with pretreatment CD4 counts < 200, 4 experienced decreased counts, intractable diarrhea, or moist desquamation requiring hospitalization. Additionally, 4 of these 8 ultimately required a colostomy either for a therapy-related complication or for salvage. Nevertheless, 6/7 in this group who received concurrent chemotherapy and radiation had their disease controlled, whereas the patient treated with radiation alone failed and required a colostomy for salvage.


CONCLUSIONS
Patients with CD4 > or = 200 had excellent disease control with acceptable morbidity. Patients with CD4 < 200 had markedly increased morbidity; however, disease was ultimately controlled in 7/8 patients.
Hoffman
R
R
Department of Radiation Oncology, University of California, San Francisco 94143-0226, USA.
Welton
M L
ML
Klencke
B
B
Weinberg
V
V
Krieg
R
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000532:radiotherapy*; D018791:CD4 Lymphocyte Count; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage; D006679:HIV Seropositivity / Q000150:complications / Q000276:immunology*; D006801:Humans; D016685:Mitomycin / Q000008:administration & dosage; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil