[Outcome of treatment of anal squamous cell carcinoma and its precursor in HIV-infected patients].
OBJECTIVE
Incidence of anal squamous cell carcinoma is increasing mainly among HIV-positive patients. Treatment consists of radiotherapy and chemotherapy, sometimes followed by tumor resection. The objective was to evaluate the follow-up of such patients to verify recurrences and evolution from HAIN to cancer. This is a report of cases treated at the "Instituto de Infectologia Emílio Ribas", Sao Paulo, Brazil.


METHODS
We attended 45 HIV-positive patients between July 1996 and June 2006. Most were male (97.7%), with ages ranging from 23 to 55 years (mean: 38.5 years). Thirty patients had high grade anal intra-epithelial neoplasia (HAIN), treated with local resection, and 15 with anal canal invasive squamous cell carcinoma were first submitted to chemo radiation, while biopsies were obtained during follow-up.


RESULTS
Patients with HAIN had recurrences in 16.7% of cases and remained cancer free for up to five years. Chemoradiation was not possible in five patients with invasive carcinoma (40%) because three had advanced AIDS and two refused treatment. Eight (88.8%) out of nine patients had complete response to chemoradiation and remained cancer free for a period from three to six years. Chemoradiation failed in the ninth patient: abdominal perineal resection was performed, and there was no recurrence over a five-year period.


CONCLUSIONS
We concluded that HAIN can recur after local resection in HIV-positive patients but does not evolve to invasive carcinoma. Invasive cancer can be treated in the same way as in HIV seronegative persons, when clinical conditions permit.
Nadal
Sidney Roberto
SR
Instituto de Infectologia Emilio Ribas, São Paulo, Brazil. srnadal@terra.com.br
Horta
Sergio Henrique Couto
SH
Calore
Edenilson Eduardo
EE
Manzione
Carmen Ruth
CR
D000328:Adult; D001005:Anus Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D017211:Treatment Failure; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000706:statistics & numerical data