Treatment of anal carcinoma in immune-compromised patients.
BACKGROUND
Immune-compromised populations show an increased incidence of anogenital tract neoplasms. This study was undertaken to evaluate local control (LC), overall survival (OS) and toxicity in immune-compromised patients with anal carcinoma treated with radiotherapy with or without chemotherapy.


METHODS
We identified 25 patients with anal carcinoma and human immunodeficiency virus (HIV) infection or history of solid-organ transplant on chronic medical immune-suppression. Median age and follow-up were 44 years and 26 months respectively. AJCC T-stages were Tis (4%), T1 (8%), T2 (58%) and T3 (29%). N-stages were N0 (79%), N1 (4%), N2 (13%) and N3 (4%). One patient had metastatic disease at diagnosis. Seventy-five percent received concurrent chemoradiotherapy. Median radiation dose to the primary tumour was 50 Gy.


RESULTS
One-, 3- and 5-year LC without salvage therapy was 87%, 87% and 70% respectively. One-, 3- and 5-year actuarial OS was 96%, 73% and 61% respectively. One-, 3- and 5-year OS was 100% for treatment time (TT) <50 days and 57%, 38% and 0% for TT > or =50 days (p=0.0009). All patients had acute grade 2-3 skin toxicity. Acute grade 3-4 gastrointestinal (GI), genitourinary (GU) and haematological toxicity occurred in 8%, 0% and 38%. Late grade 3-4 skin, GI and GU toxicity occurred in 8%, 4% and 0%.


CONCLUSIONS
Most HIV-positive and organ transplant patients receiving radiotherapy with or without chemotherapy experience acute toxicity but few have chronic complications. T-stage and CD4 level in HIV-positive patients predict for LC. T-stage and TT predict for OS.
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. rbbarrig@iupui.edu
Robert Bryan
RB
Barriger
Cindy
C
Calley
Higinia Rosa
HR
Cárdenes
D000328:Adult; D001005:Anus Neoplasms / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D002277:Carcinoma / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D003125:Colostomy / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000150:complications / Q000276:immunology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012042:Registries; D016879:Salvage Therapy; D016019:Survival Analysis; D014180:Transplantation