title: Outcomes and tolerance of human immunodeficiency virus--positive U.S. veterans undergoing dose-escalated external beam radiotherapy for localized prostate cancer.
abstract: BACKGROUND
  There are little data on the outcomes and tolerance, as well as the impact on the CD4 counts, of human immunodeficiency virus (HIV)-positive patients with prostate cancer who undergo high-dose external beam radiotherapy.
  
  
  METHODS
  We identified 15 HIV-positive patients with prostate cancer who were treated with external beam radiation to a dose ≥ 75.6 Gy at the New York Harbor Department of Veterans Affairs between 2003 and 2010. Kaplan-Meier analyses were used to measure biochemical control outcomes. Toxicity and CD4 counts before, after, and during treatments were analyzed.
  
  
  RESULTS
  A total of 15 patients were identified, with a median follow-up period of 49 months. There were 2 biochemical failures, which occurred at 28 months and 63 months, respectively. In neither of these 2 patients was there evidence of metastatic disease. The overall 5-year biochemical control was 92.3%. There appeared to be a consistent decline in the CD4 counts both during and immediately after the radiation treatments. Most of these patients had a subsequent improvement in their CD4 counts. Toxicity was mild overall, though there was 1 patient who developed rectal bleeding 11 months post treatment, which required argon plasma coagulation.
  
  
  CONCLUSIONS
  Dose-escalated external beam radiation is well tolerated in HIV-positive patients with durable biochemical control and mild toxicity. A substantial decline in CD4 counts is associated with the radiation; therefore, these counts need to be monitored closely, in conjunction with the infectious-disease specialist.
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY. Electronic address: David.schreiber@va.gov.
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY.
authors.forename: Arpit
authors.initials: A
authors.lastname: Chhabra
authors.affiliation: MD Anderson Cancer Center Orlando, Orlando, FL.
authors.forename: Justin
authors.initials: J
authors.lastname: Rineer
authors.affiliation: Cochise Oncology, Sierra Vista, AZ.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nabhani
authors.affiliation: New York Methodist Hospital, Brooklyn, NY.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Katsoulakis
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY.
authors.forename: Ramez
authors.initials: R
authors.lastname: Morkos
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Marvin
authors.initials: M
authors.lastname: Rotman
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000276:immunology / Q000401:mortality / Q000532:radiotherapy*; D016896:Treatment Outcome
keywords: CD4 count; External beam radiotherapy; Human immunodeficiency virus; Prostate cancer; Toxicity