Invasive Anal Squamous-Cell Carcinoma in the HIV-Positive Patient: Outcome in the Era of Highly Active Antiretroviral Therapy

• Published in: Diseases of the colon & rectum Vol. 51; no. 1; pp. 73 - 81
• Main Authors: Wexler, Ann, Berson, Anthony M., Goldstone, Stephen E., Waltzman, Roger, Penzer, Jason, Maisonet, Olivier G., McDermott, Bill, Rescigno, John
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 2008; The ASCRS; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Aged; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antiviral agents; Anus Neoplasms - pathology; Anus Neoplasms - therapy; Biological and medical sciences; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Colorectal Surgery; Combined Modality Therapy; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; HIV Seropositivity - complications; HIV Seropositivity - drug therapy; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Oncology; Original Contribution; Pharmacology. Drug treatments; Proportional Hazards Models; Retrospective Studies; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Surgical Oncology; Survival Rate; Treatment Outcome; Tumors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Combined-modality therapy; Anal neoplasms; Human immunodeficiency virus; Radiotherapy; Immunopathology; Squamous cell carcinoma; Prognosis; Retroviridae; Anus carcinoma; AIDS; Malignant tumor; Immune deficiency; Lentivirus; Infection; Virus; Anus; Viral disease; Digestive diseases; Intestinal disease; Antiviral; Combined treatment; Anorectal disease; Cancer
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/s10350-007-9154-7

Introduction The incidence of invasive anal squamous-cell carcinoma in patients with HIV is increasing. We report the outcome after combined chemoradiotherapy for anal squamous-cell carcinoma in HIV-infected individuals. Methods Thirty-two HIV-positive patients treated at the St. Vincent’s Cancer Care Center for anal squamous-cell carcinoma from 1997 through mid 2005 were reviewed retrospectively. All patients also received highly active antiretroviral therapy. Treatment consisted of radiotherapy concurrent with 5-fluorouracil and mitomycin C in most patients. Overall survival, anal cancer-specific survival, local recurrence, and toxicity were assessed. Results Median time from completion of radiotherapy to last follow-up of surviving patients was 35 months. Five-year locoregional relapse, anal cancer-specific survival, and overall survival were 16 , 75, and 65 percent, respectively. In multivariate analysis, locoregional recurrence, cancer-specific survival, and overall survival were all significantly associated with tumor size. Overall survival was independently associated with high viral load and low CD4 count. Acute toxicity included: Grade 3 skin in 25 percent of patients, Grade 3 diarrhea: 28 percent, and Grade 3 or 4 hematologic toxicity in 21 and 48 percent, respectively. More than two-thirds of patients required radiotherapy interruption. There was no negative impact of chemoradiotherapy on viral load. Conclusions Outcome after chemoradiotherapy for HIV-related anal squamous-cell carcinoma in the era of highly active antiretroviral therapy is comparable to outcome in patients without HIV. However, significant toxicity is seen with standard treatment regimens. Earlier diagnosis and risk-adapted therapy could lead to improved survival and decreased treatment-related morbidity.