Kauh John, Koshy Mary, Gunthel Clifford, Joyner Melissa M, Landry Jerome, Thomas Charles R
Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Oncology (Williston Park). 2005 Nov;19(12):1634-8; discussion 1638-40, 1645 passim.
Squamous cell anal cancer remains an uncommon entity; however, the incidence appears to be increasing in at-risk populations, especially those infected with human papillomavirus (HPV) and human immunodeficiency virus (HIV). Given the ability to cure this cancer using synchronous chemoradiotherapy, management practices of this disease are critical. This article considers treatment strategies for HIV-positive patients with anal cancer, including the impact on chemoradiation-induced toxicities and the role of highly active antiretroviral therapy in the treatment of this patient population. The standard treatment has been fluorouracil (5-FU) and mitomycin (or cisplatin) as chemotherapy agents plus radiation. Consideration to modifying the standard treatment regime is based on the fact that patients with HIV tend to experience greater toxicity, especially when CD4 counts are below 200; these patients also require longer treatment breaks. Additional changes to the chemotherapy dosing, such as giving 5-FU continuously and decreasing mitomycin dose, are evaluated and considered in relation to radiation field sizes in an effort to reduce toxicity, maintain local tumor control, and limit need for colostomy. The opportunity for decreasing the radiation field size and using intensity-modulated radiation therapy (IMRT) is also considered, particularly in light of the fact that IMRT provides dose-sparing while maximizing target volume dose to involved areas. The impact of the immune system in patients with HIV and squamous cell carcinoma of the anus and the associated response to therapy remains unknown. Continued studies and phase III trials will be needed to test new treatment strategies in HIV-infected patients with squamous cell cancer of the anus to determine which treatment protocols provide the greatest benefits.
肛管鳞状细胞癌仍然是一种罕见的疾病；然而，在高危人群中，尤其是感染人乳头瘤病毒（HPV）和人类免疫缺陷病毒（HIV）的人群中，其发病率似乎在上升。鉴于同步放化疗能够治愈这种癌症，该病的管理措施至关重要。本文探讨了HIV阳性肛管癌患者的治疗策略，包括对放化疗所致毒性的影响以及高效抗逆转录病毒疗法在该患者群体治疗中的作用。标准治疗方案是使用氟尿嘧啶（5-FU）和丝裂霉素（或顺铂）作为化疗药物并联合放疗。考虑对标准治疗方案进行调整的依据是，HIV患者往往会出现更大的毒性，尤其是当CD4细胞计数低于200时；这些患者也需要更长的治疗间歇期。针对化疗剂量的其他调整，如持续给予5-FU和降低丝裂霉素剂量，结合放疗野大小进行了评估和考虑，以努力降低毒性、维持局部肿瘤控制并减少结肠造口术的需求。还考虑了缩小放疗野大小并使用调强放射治疗（IMRT）的可能性，特别是鉴于IMRT在最大化靶区体积剂量的同时能实现剂量 sparing。HIV患者免疫系统对肛管鳞状细胞癌及相关治疗反应的影响尚不清楚。需要持续开展研究和进行III期试验，以测试针对HIV感染的肛管鳞状细胞癌患者的新治疗策略，从而确定哪种治疗方案能带来最大益处。
