HIV-specific differences in outcome of squamous cell carcinoma of the anal canal: a multicentric cohort study of HIV-positive patients receiving highly active antiretroviral therapy.
OBJECTIVE
To define clinical outcome after definitive chemoradiotherapy (CRT) of anal carcinoma in HIV-infected patients treated with highly active antiretroviral therapy (HAART).


METHODS
A multicentric cohort comparison of 40 HIV-positive patients with HAART and 81 HIV-negative patients treated with radiotherapy (RT) or CRT was retrospectively performed. Local disease control (LC), relapse-free survival (RFS), overall survival (OS), cancer-specific survival (CSS), toxicity, and prognostic factors were investigated.


RESULTS
HIV-positive patients were younger (mean age, 48 v 62 years; P < .0005), predominantly male (93% v 25%; P < .0005), and with early-stage (P = .06) and large-cell histology (90% v 67%; P = .005) disease. RT or CRT resulted in complete response in 92% (HIV positive) and 96% (HIV negative) of cases. Five-year OS was 61% (95% CI, 44% to 78%) in HIV-positive and 65% (95% CI, 53% to 77%) in HIV-negative patients (median follow-up, 36 months). Five-year LC was 38% (95% CI, 5% to 71%) in HIV-positive and 87% (95% CI, 79% to 95%) in HIV-negative patients (P = .008) compromising CSS and sphincter preservation. Grade 3/4 acute skin (35% v 17% [HIV negative]; P = .04) and hematologic (33% v 12% [HIV negative]; P = .08) toxicity together approximated 50% in HIV-positive patients. RFS in HIV-positive patients was associated with RT dose (P = .08) and severe acute skin toxicity (P = .04).


CONCLUSIONS
Long-term LC and acute toxicity represent major clinical challenges in HIV-positive patients with anal carcinoma. Even if fluoropyrimidine-based CRT is feasible and may result in similar response rates and OS as in HIV-negative patients, improved treatment strategies with better long-term outcome are warranted.
Oehler-Jänne
Christoph
C
Department of Radiation Oncology, Pathology, and the Center for Clinical Research Zurich University Hospital, Switzerland.
Huguet
Florence
F
Provencher
Sawyna
S
Seifert
Burkhardt
B
Negretti
Laura
L
Riener
Marc-Oliver
MO
Bonet
Marta
M
Allal
Abdelkarim S
AS
Ciernik
I Frank
IF
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000401:mortality / Q000628:therapy* / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy* / Q000821:virology; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome