title: Combined modality therapy for HIV-infected patients with squamous cell carcinoma of the anus: outcomes and toxicities.
abstract: OBJECTIVE
  We report toxicity and survival data of human immunodeficiency virus (HIV)-infected men with anal carcinoma treated with combined modality therapy (CMT) of radiotherapy and concurrent chemotherapy.
  
  
  METHODS
  A retrospective review was performed on the records of 17 HIV-positive patients with anal squamous cell carcinoma treated with CMT at our institution between 1991 and 2004. Radiotherapy consisted of 30.6 to 45 Gy to the pelvis, total dose of 50.4 to 59.4 Gy to initial gross disease, at 1.8 Gy/fraction. Chemotherapy consisted of 5-fluorouracil and either mitomycin C or cisplatin. The mean follow-up was 25.6 months (median, 15.6 months; range, 4.6-106 months).
  
  
  RESULTS
  Significant acute skin and hematologic toxicity developed in 8 of 17 and 9 of 17 patients, respectively. One patient died 12 days after treatment of progressive disease and sepsis. Significant late toxic sequelae developed in 3 patients: 1 anorectal ulcer, 2 dermatologic (perianal ulceration, hemorrhagic perineal sores and suspected fissure). Fourteen of 15 patients with Stage I-III disease had a complete response; 2 complete responders subsequently had a relapse in the anorectum. For all patients, actuarial 18-month survival was 67%. For patients with Stage I-III disease, survival at last follow-up by low CD4 count (<200) vs. high count (>200) was 4 of 7 vs. 7 of 8, respectively; significant acute toxicities developed in 4 of 8 vs. 6 of 9, respectively.
  
  
  CONCLUSIONS
  For HIV patients with anal carcinoma, CMT yields reasonable local control with significant acute complications. Survival is lower than in the general population, attributable more to the underlying infection than to the malignancy.
authors.affiliation: Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA. scotte@radonc.emory.org
authors.forename: Scott
authors.initials: S
authors.lastname: Edelman
authors.forename: Peter A S
authors.initials: PA
authors.lastname: Johnstone
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects; D010198:Pancytopenia / Q000139:chemically induced; D011879:Radiotherapy Dosage; D012003:Rectal Fistula / Q000150:complications; D012189:Retrospective Studies
chemical_list: D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil