title: Anal carcinoma in HIV-infected patients in the era of antiretroviral therapy: a comparative study.
abstract: BACKGROUND
  Before the introduction of highly active antiretroviral therapy, prognosis of anal squamous-cell carcinoma was worse when patients were infected with HIV. Since then, contradictory results have been reported.
  
  
  OBJECTIVE
  To compare the results of chemoradiotherapy in HIV-infected and uninfected patients with anal carcinoma.
  
  
  METHODS
  Retrospective analysis of medical records.
  
  
  METHODS
  Tertiary care center in France.
  
  
  METHODS
  Patients with invasive anal carcinoma treated from 2001 through 2006.
  
  
  METHODS
  Chemoradiotherapy included 60 Gy pelvic irradiation and cisplatin-based chemotherapy. Surgery was performed for local failures or complications.
  
  
  METHODS
  Tolerance for chemoradiotherapy, tumor control, and survival were evaluated.
  
  
  RESULTS
  A total of 46 patients (20 HIV-infected and 26 uninfected) were treated for nonmetastatic anal carcinoma. Median follow-up was 32.5 (range, 7-84) months. HIV-infected patients were more likely to be men (95% vs 23%, P < .001) and were younger (median age, 46 vs 62 years, P < .001) than uninfected patients. The viral load was less than 200 copies/mL in 15 (75%) of the HIV-infected patients. The duration of chemoradiotherapy was longer in HIV-infected than in uninfected patients (median, 103 vs 84 days, P = .027). Chemoradiotherapy failed to achieve local control in 10 (50%) HIV-infected and in 6 (23%) uninfected patients (P = .057). In HIV-infected patients, failure rates were higher in patients who required prolonged chemoradiotherapy than in those who received treatment as scheduled (7/11, 64% vs 1/7, 14%; P = .039). During follow-up, 7 (35%) of the HIV-infected and 3 (12%) of the uninfected patients died, all from anal carcinoma. The 5-year overall survival rate was 39% for HIV-infected and 84% for uninfected patients (P = .026); 5-year disease-free survival was 37% in HIV-infected and 75% in uninfected patients (P = .06).
  
  
  CONCLUSIONS
  Retrospective design, lack of data regarding precise toxicity grading, and use of cisplatin-based chemoradiotherapy.
  
  
  CONCLUSIONS
  Even in the era of highly active antiretroviral therapy, HIV-infected patients with anal squamous-cell carcinoma show impaired tolerance to chemoradiotherapy, have a lower survival rate, and may have a higher rate of local failure compared with uninfected patients.
authors.affiliation: Department of Digestive and Endocrine Surgery, Hôpital Saint-Louis, Paris, France. nicolas.munozbongrand@sls.aphp.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.forename: Tigran
authors.initials: T
authors.lastname: Poghosyan
authors.forename: Sarah
authors.initials: S
authors.lastname: Zohar
authors.forename: Laurence
authors.initials: L
authors.lastname: Gerard
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
authors.forename: Laurent
authors.initials: L
authors.lastname: Quero
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Gornet
authors.forename: Pierre
authors.initials: P
authors.lastname: Cattan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005602:France; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D019562:Viral Load