Anal carcinoma, a common disease in HIV-positive patients, is usually treated with chemoradiotherapy.
Generally tolerance was poor before the availability of highly active antiretroviral therapies.
Dr Christophe Hennequin and colleagues from France report their experience of treating anal carcinoma in the era of new antiviral drugs.
|8 of 9 patients were disease-free after a median follow-up of 33 months|
|Diseases of the Colon & Rectum|
The team included 9 male participants on highly active antiretroviral therapies with good immune status before chemoradiotherapy between 1997 and 2001.
The participants received concomitant chemoradiotherapy consisting of 5-fluorouracil and cisplatinum, and high-dose radiotherapy for anal carcinoma.
The researchers noted that 6 cancers were Stage I, 2 were Stage II, and 1 was Stage III.
The team observed that the CD4+ cell counts were less than 200 ml-1 for 4 patients, between 200 ml-1 and 500 ml-1 for 4, and less than 500 ml-1 for 1.
All patients received the planned dose of radiation of equal to or more than 60 Gy with an overall treatment time of 58 days.
The researchers reported that the chemotherapy dose was reduced 25% in 6 patients.
The research team found that Grade 3 hematologic or skin toxicity occurred in 4 patients.
The team observed no association between high-grade toxicity and CD4+ cell count.
None of the patients developed opportunistic infections during follow-up.
The researchers noted that 8 patients were disease-free after a median follow-up of 33 months.
Among them, the team found that 4 had no or minor anal function impairment at the last follow-up visit.
The researchers reported that 1 patient with T4N2 disease relapsed locally 1 year after treatment and underwent salvage abdominoperineal excision.
Dr Hennequin's team concludes, “High-dose chemoradiotherapy for anal carcinomas is feasible with low toxicity in HIV-positive patients treated with highly active antiretroviral therapies.”
“Local control is similar to that obtained for HIV-negative patients.”