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.
Dr Ingeborg Fraunholz and colleagues 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.
The research team performed a retrospective single-institution chart review.
Between 1997 and 2012, 36 HIV-positive patients were treated with standard chemoradiotherapy.
The team performed 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.
|5-year overall survival was 74%|
|Diseases of the Colon & Rectum|
Chemoradiotherapy could be completed in all patients.
The researchers found that acute grade 3 toxicities occurred in 47% of patients.
Complete response was achieved in 86% of patients.
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.
The team noted that 11% of patients experienced opportunistic illnesses during the follow-up.
Dr Fraunholz's team concludes, "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."