Local tumor control and toxicity in HIV-associated anal carcinoma treated with radiotherapy in the era of antiretroviral therapy.
OBJECTIVE
To investigate the outcome of HIV-seropositive patients under highly active antiretroviral treatment (HAART) with anal cancer treated with radiotherapy (RT) alone or in combination with standard chemotherapy (CT).


METHODS
Clinical outcome of 81 HIV-seronegative patients (1988-2003) and 10 consecutive HIV-seropositive patients under HAART (1997-2003) that were treated with 3-D conformal RT of 59.4 Gy and standard 5-fluorouracil and mitomycin-C were retrospectively analysed. 10 TNM-stage and age matched HIV-seronegative patients (1992-2003) were compared with the 10 HIV-seropositive patients. Pattern of care, local disease control (LC), overall survival (OS), cancer-specific survival (CSS), and toxicity were assessed.


RESULTS
RT with or without CT resulted in complete response in 100% of HIV-seropositive patients. LC was impaired compared to matched HIV-seronegative patients after a median follow-up of 44 months (p = 0.03). OS at 5 years was 70% in HIV-seropositive patients receiving HAART and 69% in the matched controls. Colostomy-free survival was 70% (HIV+) and 100% (matched HIV-) and 78% (all HIV-). No HIV-seropositive patient received an interstitial brachytherapy boost compared to 42% of all HIV-seronegative patients and adherence to chemotherapy seemed to be difficult in HIV-seropositive patients. Acute hematological toxicity reaching 50% was high in HIV-seropositive patients receiving MMC compared with 0% in matched HIV-seronegative patients (p = 0.05) or 12% in all HIV-seronegative patients. The rate of long-term side effects was low in HIV-seropositive patients.


CONCLUSIONS
Despite high response rates to organ preserving treatment with RT with or without CT, local tumor failure seems to be high in HIV-positive patients receiving HAART. HIV-seropositive patients are subject to treatment bias, being less likely treated with interstitial brachytherapy boost probably due to HIV-infection, and they are at risk to receive less chemotherapy.
Oehler-Jänne
Christoph
C
Radiation Oncology, Zurich University Hospital, Switzerland. christoph.oehler@usz.ch
Seifert
Burkhardt
B
Lütolf
Urs M
UM
Ciernik
I Frank
IF
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000821:virology*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D011878:Radiotherapy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D016685:Mitomycin; D005472:Fluorouracil