Blazy Anne, Hennequin Christophe, Gornet Jean-Marc, Furco André, Gérard Laurence, Lémann Marc, Maylin Claude
Service de Cancérologie-Radiothérapie, Hôpital Saint-Louis, Paris, France.
Dis Colon Rectum. 2005 Jun;48(6):1176-81. doi: 10.1007/s10350-004-0910-7.
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. We report our experience of treating anal carcinoma in the era of new antiviral drugs.
Between 1997 and 2001, nine men on highly active antiretroviral therapies with good immune status before chemoradiotherapy received concomitant chemoradiotherapy consisting of 5-fluorouracil and cisplatinum, and high-dose radiotherapy (60-70 Gy) for anal carcinoma. Six cancers were Stage I, two were Stage II, and one was Stage III. CD4+ cell counts were <200/ml for four patients, between 200/ml and 500/ml for four, and >500/ml for one.
All patients received the planned dose of radiation (> or = 60 Gy). The chemotherapy dose was reduced 25 percent in six patients. Overall treatment time was 58 days. Grade 3 hematologic or skin toxicity occurred in four patients. No association was observed between high-grade toxicity and CD4+ cell count. None of the patients developed opportunistic infections during follow-up. Eight patients were disease-free after a median follow-up of 33 months. Among them, four had no or minor anal function impairment at the last follow-up visit. One patient with T4N2 disease relapsed locally one year after treatment and underwent salvage abdominoperineal excision.
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.
肛管癌是HIV阳性患者的常见疾病，通常采用放化疗进行治疗。在高效抗逆转录病毒疗法出现之前，一般耐受性较差。我们报告了在新型抗病毒药物时代治疗肛管癌的经验。
1997年至2001年间，9名在放化疗前免疫状态良好且接受高效抗逆转录病毒疗法的男性患者，接受了由5-氟尿嘧啶和顺铂组成的同步放化疗以及针对肛管癌的高剂量放疗（60-70 Gy）。6例癌症为I期，2例为II期，1例为III期。4例患者的CD4+细胞计数<200/ml，4例在200/ml至500/ml之间，1例>500/ml。
所有患者均接受了计划剂量的放疗（≥60 Gy）。6例患者的化疗剂量减少了25%。总体治疗时间为58天。4例患者出现3级血液学或皮肤毒性。未观察到高级别毒性与CD4+细胞计数之间存在关联。随访期间所有患者均未发生机会性感染。中位随访33个月后，8例患者无疾病进展。其中，4例在最后一次随访时肛门功能无损害或仅有轻微损害。1例T4N2期疾病患者在治疗1年后局部复发，接受了挽救性腹会阴切除术。
对于接受高效抗逆转录病毒疗法治疗的HIV阳性患者，高剂量放化疗治疗肛管癌具有低毒性且可行。局部控制情况与HIV阴性患者相似。
