Department of Digestive and Endocrine Surgery, Hôpital Saint-Louis, Paris, France.
Dis Colon Rectum. 2011 Jun;54(6):729-35. doi: 10.1007/DCR.0b013e3182137de9.
Before the introduction of highly active antiretroviral therapy, prognosis of anal squamous-cell carcinoma was worse when patients were infected with HIV. Since then, contradictory results have been reported.
To compare the results of chemoradiotherapy in HIV-infected and uninfected patients with anal carcinoma.
Retrospective analysis of medical records.
Tertiary care center in France.
Patients with invasive anal carcinoma treated from 2001 through 2006.
Chemoradiotherapy included 60 Gy pelvic irradiation and cisplatin-based chemotherapy. Surgery was performed for local failures or complications.
Tolerance for chemoradiotherapy, tumor control, and survival were evaluated.
A total of 46 patients (20 HIV-infected and 26 uninfected) were treated for nonmetastatic anal carcinoma. Median follow-up was 32.5 (range, 7-84) months. HIV-infected patients were more likely to be men (95% vs 23%, P < .001) and were younger (median age, 46 vs 62 years, P < .001) than uninfected patients. The viral load was less than 200 copies/mL in 15 (75%) of the HIV-infected patients. The duration of chemoradiotherapy was longer in HIV-infected than in uninfected patients (median, 103 vs 84 days, P = .027). Chemoradiotherapy failed to achieve local control in 10 (50%) HIV-infected and in 6 (23%) uninfected patients (P = .057). In HIV-infected patients, failure rates were higher in patients who required prolonged chemoradiotherapy than in those who received treatment as scheduled (7/11, 64% vs 1/7, 14%; P = .039). During follow-up, 7 (35%) of the HIV-infected and 3 (12%) of the uninfected patients died, all from anal carcinoma. The 5-year overall survival rate was 39% for HIV-infected and 84% for uninfected patients (P = .026); 5-year disease-free survival was 37% in HIV-infected and 75% in uninfected patients (P = .06).
Retrospective design, lack of data regarding precise toxicity grading, and use of cisplatin-based chemoradiotherapy.
Even in the era of highly active antiretroviral therapy, HIV-infected patients with anal squamous-cell carcinoma show impaired tolerance to chemoradiotherapy, have a lower survival rate, and may have a higher rate of local failure compared with uninfected patients.
在高效抗逆转录病毒疗法引入之前，艾滋病毒感染者的肛门鳞癌预后较差。从那时起，就有了相互矛盾的结果。
比较感染和未感染 HIV 的肛门癌患者接受放化疗的结果。
病历回顾性分析。
法国的一家三级保健中心。
2001 年至 2006 年期间接受侵袭性肛门癌治疗的患者。
放化疗包括 60 Gy 盆腔照射和基于顺铂的化疗。对于局部复发或并发症，进行手术治疗。
评估放化疗的耐受性、肿瘤控制和生存率。
共有 46 例（20 例 HIV 感染，26 例未感染）患者接受非转移性肛门癌治疗。中位随访时间为 32.5（范围，7-84）个月。HIV 感染患者更可能是男性（95%对 23%，P<.001），且年龄更小（中位年龄 46 岁对 62 岁，P<.001）。15 例（75%）HIV 感染患者的病毒载量低于 200 拷贝/ml。与未感染的患者相比，HIV 感染患者的放化疗时间更长（中位数 103 天对 84 天，P=.027）。10 例（50%）HIV 感染患者和 6 例（23%）未感染患者的放化疗未能达到局部控制（P=.057）。在 HIV 感染患者中，需要延长放化疗的患者比按计划接受治疗的患者失败率更高（7/11，64%对 1/7，14%；P=.039）。在随访期间，7 例（35%）HIV 感染患者和 3 例（12%）未感染患者死于肛门癌。HIV 感染患者的 5 年总生存率为 39%，未感染患者为 84%（P=.026）；HIV 感染患者的 5 年无病生存率为 37%，未感染患者为 75%（P=.06）。
回顾性设计，缺乏关于确切毒性分级的数据，以及使用顺铂为基础的放化疗。
即使在高效抗逆转录病毒治疗时代，HIV 感染的肛门鳞癌患者对放化疗的耐受性较差，生存率较低，与未感染患者相比，局部失败的发生率可能更高。
