Combined modality therapy for HIV-infected patients with squamous cell carcinoma of the anus: outcomes and toxicities.

PURPOSE

We report toxicity and survival data of human immunodeficiency virus (HIV)-infected men with anal carcinoma treated with combined modality therapy (CMT) of radiotherapy and concurrent chemotherapy.

METHODS AND MATERIALS

A retrospective review was performed on the records of 17 HIV-positive patients with anal squamous cell carcinoma treated with CMT at our institution between 1991 and 2004. Radiotherapy consisted of 30.6 to 45 Gy to the pelvis, total dose of 50.4 to 59.4 Gy to initial gross disease, at 1.8 Gy/fraction. Chemotherapy consisted of 5-fluorouracil and either mitomycin C or cisplatin. The mean follow-up was 25.6 months (median, 15.6 months; range, 4.6-106 months).

RESULTS

Significant acute skin and hematologic toxicity developed in 8 of 17 and 9 of 17 patients, respectively. One patient died 12 days after treatment of progressive disease and sepsis. Significant late toxic sequelae developed in 3 patients: 1 anorectal ulcer, 2 dermatologic (perianal ulceration, hemorrhagic perineal sores and suspected fissure). Fourteen of 15 patients with Stage I-III disease had a complete response; 2 complete responders subsequently had a relapse in the anorectum. For all patients, actuarial 18-month survival was 67%. For patients with Stage I-III disease, survival at last follow-up by low CD4 count (<200) vs. high count (>200) was 4 of 7 vs. 7 of 8, respectively; significant acute toxicities developed in 4 of 8 vs. 6 of 9, respectively.

CONCLUSION

For HIV patients with anal carcinoma, CMT yields reasonable local control with significant acute complications. Survival is lower than in the general population, attributable more to the underlying infection than to the malignancy.