title: Long-term effects of chemoradiotherapy for anal cancer in patients with HIV infection: oncological outcomes, immunological status, and the clinical course of the HIV disease.
abstract: BACKGROUND
  Despite the increasing evidence for chemoradiotherapy as standard treatment for anal cancer in patients with HIV infection, there is still some uncertainty regarding increased toxicity and adverse effects on the immune status.
  
  
  OBJECTIVE
  We report the clinical outcome of 5-fluorouracil/mitomycin C-based concurrent chemoradiotherapy for anal carcinoma in patients with HIV infection with an emphasis on the long-term course of CD4 counts and the HIV-related morbidity during follow-up.
  
  
  METHODS
  A retrospective single-institution chart review was performed.
  
  
  METHODS
  Between 1997 and 2012, 36 HIV-positive patients were treated with standard chemoradiotherapy (median tumor dose, 54 (range, 50.4-60.4) Gy at 1.8 Gy/fraction; 5-fluorouracil, 800-1000 mg/m(2), days 1-4 or 1-5; mitomycin C, 10 mg/m(2), day 1, in the first and fifth week).
  
  
  METHODS
  A retrospective analysis was performed with respect to tumor response, local control, cancer and overall survival, and toxicity. Immunological parameters, including pre- and posttreatment CD4 counts, viral load, and HIV-specific morbidity were recorded during follow-up.
  
  
  RESULTS
  Chemoradiotherapy could be completed in all patients. Acute grade 3 toxicities occurred in 17/36 patients (47%). Complete response was achieved in 31 patients (86%). Five-year local control, colostomy-free, cancer-specific, and overall survival were 72%, 87%, 77%, and 74%. The median pretreatment CD4 count significantly decreased from 367 cells/μL to 139 cells/μL, 3 to 7 weeks after completion of chemoradiotherapy (p < 0.001). Four patients (11%) experienced opportunistic illnesses during the follow-up (median, 66; range, 10-164 months).
  
  
  CONCLUSIONS
  This study is limited by its retrospective design and its small sample size.
  
  
  CONCLUSIONS
  Our data confirm again that, in the highly active antiretroviral therapy era, anal cancer can be treated in HIV-positive patients with standard chemoradiotherapy, with a clinical outcome similar to their HIV-negative counterparts. The chemoradiotherapy-related decline of the CD4 counts, which remain decreased up to 6 years after chemoradiotherapy, was not associated with increased HIV-related clinical morbidity.
authors.affiliation: 1Department of Radiation Oncology, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany 2HIV Treatment & Clinical Research Unit, Department of Internal Medicine II, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany 3Infectiologicum, Frankfurt/Main, Germany.
authors.forename: Ingeborg B
authors.initials: IB
authors.lastname: Fraunholz
authors.forename: Annette
authors.initials: A
authors.lastname: Haberl
authors.forename: Stephan
authors.initials: S
authors.lastname: Klauke
authors.forename: Peter
authors.initials: P
authors.lastname: Gute
authors.forename: Claus M
authors.initials: CM
authors.lastname: Rödel
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D018791:CD4 Lymphocyte Count; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D010349:Patient Compliance; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000970:Antineoplastic Agents; D016685:Mitomycin; D005472:Fluorouracil