Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA.
Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):16-21. doi: 10.1016/j.ijrobp.2011.05.047. Epub 2011 Nov 19.
To compare the biochemical outcome and toxicity scores of men with human immunodeficiency virus (HIV) and prostate cancer with a matched control population with negative or unknown HIV status when treated with external-beam radiotherapy (EBRT).
A single-institution database of men with prostate cancer treated with EBRT from 1999 to 2009 was reviewed. Thirteen men with HIV were identified and matched to 2 control patients according to age, race, T stage, prostate-specific antigen level, Gleason score, RT dose, intensity-modulated RT vs. three-dimensional conformal RT, and whole-pelvis vs. prostate-only RT, for a total of 39 cases. The median follow-up time was 39 months (range, 3-110 months).
The 4-year biochemical failure (BF)-free survival rate was 87% in the HIV-positive group vs. 89% in the controls (p = 0.94). Pre- and post-RT viral loads were found to be predictive of BF (p = 0.04 and p = 0.04, respectively). No men with HIV died, whereas 2 in the control group died of causes unrelated to prostate cancer. Acute and chronic genitourinary and gastrointestinal toxicity were less in the HIV-positive patients than in controls (p < 0.001, p < 0.001, p = 0.003, and p < 0.001, respectively). The HIV-positive men experienced an average decline in CD4 count of 193 cells/mm(3).
Our findings suggest that men with HIV treated with EBRT have a similar risk of BF; however, high viral loads may contribute to an increased risk. This analysis supports that HIV-positive men with prostate cancer can be treated with definitive EBRT with similar disease control and toxicity outcomes as in the general population.
比较患有人类免疫缺陷病毒 (HIV) 和前列腺癌的男性与 HIV 阴性或未知的匹配对照人群在接受外照射放射治疗 (EBRT) 时的生化结果和毒性评分。
回顾了 1999 年至 2009 年期间接受 EBRT 治疗的前列腺癌男性的单机构数据库。确定了 13 名 HIV 阳性男性，并根据年龄、种族、T 分期、前列腺特异性抗原水平、Gleason 评分、RT 剂量、调强放射治疗与三维适形放射治疗、全骨盆与前列腺单野放疗进行匹配，共 39 例。中位随访时间为 39 个月（范围，3-110 个月）。
HIV 阳性组的 4 年生化无失败（BF）生存率为 87%，对照组为 89%（p = 0.94）。治疗前后的病毒载量与 BF 相关（p = 0.04 和 p = 0.04）。没有 HIV 阳性男性死亡，而对照组中有 2 人死于与前列腺癌无关的原因。HIV 阳性患者的急性和慢性泌尿生殖系统和胃肠道毒性均低于对照组（p < 0.001，p < 0.001，p = 0.003，p < 0.001）。HIV 阳性男性的 CD4 计数平均下降了 193 个细胞/mm3。
我们的发现表明，接受 EBRT 治疗的 HIV 阳性男性的 BF 风险相似；然而，高病毒载量可能会增加风险。该分析支持 HIV 阳性前列腺癌患者可以采用根治性 EBRT 治疗，与一般人群的疾病控制和毒性结果相似。
