title: Long-term outcome of seropositive HIV patients with head and neck squamous cell carcinoma treated with radiation therapy and chemotherapy.
abstract: OBJECTIVE
  To report the outcome of radiation therapy (RT) +/- chemotherapy in HIV-seropositive patients with Head and Neck Squamous Cell Carcinoma (HNSCC).
  
  
  METHODS
  This is the largest single-Institution retrospective study to date, consisting of 73 HIV patients with HNSCC treated from January 1997-2010. The median age at RT, HIV diagnosis and the duration of patients being HIV seropositive were 51, 34, and 11 years, respectively. Seventy patients had SCC and one had submandibular salivary duct carcinoma. Stages I-II, III and IVA/B were: 22%, 27% and 51%, respectively. Primary cancer sites comprised the larynx (37%), oropharynx (32%), oral cavity (13%), hypopharynx (7%), nasopharynx (4%), unknown primary (MUP) (4%), nasal cavity (3%), and submandibular salivary duct (1%). All patients had an ECOG performance scale of ≤1 and were treated with RT +/- chemotherapy. Fifty patients (70%) were on highly active anti-retroviral therapy (HAART) during treatment, and the median CD4 count was 290 (range: 203-1142). Median dose of 70, 63, and 54 Gy were delivered to the gross disease, high-risk neck, and low-risk neck respectively. Median duration of treatment was 52 (range: 49-64) days. Twelve patients (17%) underwent neck dissection for N3 disease.
  
  
  RESULTS
  After a median follow-up of 47 months (range: 7-140), the 4-year locoregional control (LRC) and overall survival (OS) were 69% and 55% respectively. Seven patients (10%) developed second primary sites within the first 5 years of completing RT (2 anal SCCs and 5 HNSCCs). The LRC for Stages III/IV larynx and oropharynx SCC (which represent the majority of the cohort) were 76% and 70%, respectively. Chemo/RT-related late toxicities were dysphagia of grade≤2, 3, and 4 found in 74%, 15% and 11% of patients, respectively. Hoarseness (grade 1) was reported in 10% of patients; no patient experienced grade ≥2. Xerostomia grade ≤2, and 3 was found in 77% and 23% of patients, respectively. A Chi-square test and univariate analysis showed statistically significant relationships between LRC and duration of RT (p<0.001), as well as positive trends for weight loss (<10%) and absence of second malignancy.
  
  
  CONCLUSIONS
  Definitive RT +/- chemotherapy for HIV-seropositive patients with HNSCC appears to be less effective compared to the observed rates of LRC and OS of other HNSCC without HIV. Due to advances in the HAART which prolongs HIV patients' survival, it is extremely important to establish better treatment strategies to improve therapeutic ratio in this growing patient population.
authors: Department of Radiation Oncology, Beth Israel Medical Center (BIMC), Continuum Cancer Centers of New York (CCCNY), 10 Union Square E. Suite 4 G, New York, NY, 10003, U.S.A. Waleed246@gmail.com.
authors: Waleed F
authors: WF
authors: Mourad
authors: Kenneth S
authors: KS
authors: Hu
authors: Daniel
authors: D
authors: Shasha
authors: Catherine
authors: C
authors: Concert
authors: Dan
authors: D
authors: Ishihara
authors: Wilson
authors: W
authors: Lin
authors: Mauricio E
authors: ME
authors: Gamez
authors: John N
authors: JN
authors: Lukens
authors: John J
authors: JJ
authors: Lukens
authors: Rania A
authors: RA
authors: Shourbaji
authors: Magdalena
authors: M
authors: Ryniak
authors: Zujun
authors: Z
authors: Li
authors: Bruce E
authors: BE
authors: Culliney
authors: Azita S
authors: AS
authors: Khorsandi
authors: Theresa
authors: T
authors: Tran
authors: Adam
authors: A
authors: Jacobson
authors: Spiros
authors: S
authors: Manolidis
authors: Stimson
authors: S
authors: Schantz
authors: Mark
authors: M
authors: Urken
authors: Mark S
authors: MS
authors: Persky
authors: Louis B
authors: LB
authors: Harrison
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy; D006679:HIV Seropositivity; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: CD4; HIV; IMRT; Viral Load; chemotherapy; concurrent chemoradiotherapy; head and neck cancer; radiation therapy; squamous cell carcinoma