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Dis Colon Rectum. 2011 Jun;54(6):729-35. doi: 10.1007/DCR.0b013e3182137de9.

Anal carcinoma in HIV-infected patients in the era of antiretroviral therapy: a comparative study.

Author information

1
Department of Digestive and Endocrine Surgery, Hôpital Saint-Louis, Paris, France. nicolas.munozbongrand@sls.aphp.fr

Abstract

BACKGROUND:

Before the introduction of highly active antiretroviral therapy, prognosis of anal squamous-cell carcinoma was worse when patients were infected with HIV. Since then, contradictory results have been reported.

OBJECTIVE:

To compare the results of chemoradiotherapy in HIV-infected and uninfected patients with anal carcinoma.

DESIGN:

Retrospective analysis of medical records.

SETTING:

Tertiary care center in France.

PATIENTS:

Patients with invasive anal carcinoma treated from 2001 through 2006.

INTERVENTIONS:

Chemoradiotherapy included 60 Gy pelvic irradiation and cisplatin-based chemotherapy. Surgery was performed for local failures or complications.

MAIN OUTCOME MEASURES:

Tolerance for chemoradiotherapy, tumor control, and survival were evaluated.

RESULTS:

A total of 46 patients (20 HIV-infected and 26 uninfected) were treated for nonmetastatic anal carcinoma. Median follow-up was 32.5 (range, 7-84) months. HIV-infected patients were more likely to be men (95% vs 23%, P < .001) and were younger (median age, 46 vs 62 years, P < .001) than uninfected patients. The viral load was less than 200 copies/mL in 15 (75%) of the HIV-infected patients. The duration of chemoradiotherapy was longer in HIV-infected than in uninfected patients (median, 103 vs 84 days, P = .027). Chemoradiotherapy failed to achieve local control in 10 (50%) HIV-infected and in 6 (23%) uninfected patients (P = .057). In HIV-infected patients, failure rates were higher in patients who required prolonged chemoradiotherapy than in those who received treatment as scheduled (7/11, 64% vs 1/7, 14%; P = .039). During follow-up, 7 (35%) of the HIV-infected and 3 (12%) of the uninfected patients died, all from anal carcinoma. The 5-year overall survival rate was 39% for HIV-infected and 84% for uninfected patients (P = .026); 5-year disease-free survival was 37% in HIV-infected and 75% in uninfected patients (P = .06).

LIMITATIONS:

Retrospective design, lack of data regarding precise toxicity grading, and use of cisplatin-based chemoradiotherapy.

CONCLUSIONS:

Even in the era of highly active antiretroviral therapy, HIV-infected patients with anal squamous-cell carcinoma show impaired tolerance to chemoradiotherapy, have a lower survival rate, and may have a higher rate of local failure compared with uninfected patients.

PMID:
21552058
DOI:
10.1007/DCR.0b013e3182137de9
[Indexed for MEDLINE]

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