title: Are there HIV-specific Differences for Anal Cancer Patients Treated with Standard Chemoradiotherapy in the Era of Combined Antiretroviral Therapy?
abstract: Contradicting evidence exists regarding the safety and clinical outcome of standard treatment in HIV-positive patients with anal cancer. We report on our large, single-centre experience in HIV-positive versus HIV-negative patients treated in the era of combined antiretroviral therapy (CART).
  
  
  
  Between 1997 and 2015, 142 patients (42 HIV-positive versus 100 HIV-negative) with anal cancer were treated with standard chemoradiotherapy. Patients received a median dose of 50.4 Gy to the planning target volume; 91 (64%) patients received an external boost to the primary tumour and/or enlarged lymph nodes of 5.4-10.8 Gy. Concurrent chemotherapy was scheduled in the first and fifth weeks of radiotherapy using 5-fluorouracil and mitomycin C. The median follow-up was 51 (range 0-325) months.
  
  
  
  HIV-positive patients were predominantly male (P<0.001), younger (P<0.001) and had more advanced nodal disease (P=0.042). A dose reduction of chemotherapy was necessary in 38% of HIV-positive patients and in 24% of HIV-negative patients (P=0.39). There was no significant difference in total dose or duration of radiotherapy (median 43 versus 44 days, P=0.59). Complete response (81% versus 87%, P=0.088), 5 year rates of local failure (26.2% versus 14.9%, P=0.176), 5 year rates of distant failure (14.3% versus 8.4%, P=0.371) and 5 year overall survival (70.7% versus 78.4%, P=0.491) were not significantly different. HIV-positive patients had worse 5 year cancer-specific survival (80.5% versus 93.8%, P=0.029) in univariate but not in multivariate analysis (P=0.276).
  
  
  
  In the CART era, tolerance and clinical outcome are similar between HIV-positive and HIV-negative patients with anal cancer after standard chemoradiotherapy.
authors.affiliation: Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt am Main, Germany. Electronic address: daniel.martin@kgu.de.
authors.forename: D
authors.initials: D
authors.lastname: Martin
authors.affiliation: Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt am Main, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany and German Cancer Consortium (DKTK) Partner Site, Frankfurt, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Balermpas
authors.affiliation: Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt am Main, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany and German Cancer Consortium (DKTK) Partner Site, Frankfurt, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Fokas
authors.affiliation: Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt am Main, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany and German Cancer Consortium (DKTK) Partner Site, Frankfurt, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Rödel
authors.affiliation: Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt am Main, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Yildirim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000150:complications / Q000628:therapy* / Q000821:virology; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents
keywords: Anal carcinoma; HIV; cancer-specific survival; chemoradiotherapy; local control; overall survival