Martin D, Balermpas P, Fokas E, Rödel C, Yildirim M
Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt am Main, Germany.
Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt am Main, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany and German Cancer Consortium (DKTK) Partner Site, Frankfurt, Germany.
Clin Oncol (R Coll Radiol). 2017 Apr;29(4):248-255. doi: 10.1016/j.clon.2016.12.010. Epub 2016 Dec 31.
Contradicting evidence exists regarding the safety and clinical outcome of standard treatment in HIV-positive patients with anal cancer. We report on our large, single-centre experience in HIV-positive versus HIV-negative patients treated in the era of combined antiretroviral therapy (CART).
Between 1997 and 2015, 142 patients (42 HIV-positive versus 100 HIV-negative) with anal cancer were treated with standard chemoradiotherapy. Patients received a median dose of 50.4 Gy to the planning target volume; 91 (64%) patients received an external boost to the primary tumour and/or enlarged lymph nodes of 5.4-10.8 Gy. Concurrent chemotherapy was scheduled in the first and fifth weeks of radiotherapy using 5-fluorouracil and mitomycin C. The median follow-up was 51 (range 0-325) months.
HIV-positive patients were predominantly male (P<0.001), younger (P<0.001) and had more advanced nodal disease (P=0.042). A dose reduction of chemotherapy was necessary in 38% of HIV-positive patients and in 24% of HIV-negative patients (P=0.39). There was no significant difference in total dose or duration of radiotherapy (median 43 versus 44 days, P=0.59). Complete response (81% versus 87%, P=0.088), 5 year rates of local failure (26.2% versus 14.9%, P=0.176), 5 year rates of distant failure (14.3% versus 8.4%, P=0.371) and 5 year overall survival (70.7% versus 78.4%, P=0.491) were not significantly different. HIV-positive patients had worse 5 year cancer-specific survival (80.5% versus 93.8%, P=0.029) in univariate but not in multivariate analysis (P=0.276).
In the CART era, tolerance and clinical outcome are similar between HIV-positive and HIV-negative patients with anal cancer after standard chemoradiotherapy.
关于HIV阳性肛门癌患者标准治疗的安全性和临床结局，存在相互矛盾的证据。我们报告了在联合抗逆转录病毒治疗（CART）时代，我们在HIV阳性与HIV阴性患者中的大型单中心经验。
1997年至2015年间，142例肛门癌患者（42例HIV阳性，100例HIV阴性）接受了标准放化疗。患者计划靶体积接受的中位剂量为50.4 Gy；91例（64%）患者对原发肿瘤和/或肿大淋巴结接受了5.4 - 10.8 Gy的外照射增敏。在放疗的第1周和第5周使用5-氟尿嘧啶和丝裂霉素C进行同步化疗。中位随访时间为51（范围0 - 325）个月。
HIV阳性患者以男性为主（P<0.001），更年轻（P<0.001），且有更晚期的淋巴结疾病（P = 0.042）。38%的HIV阳性患者和24%的HIV阴性患者需要减少化疗剂量（P = 0.39）。放疗的总剂量或持续时间无显著差异（中位43天对44天，P = 0.59）。完全缓解率（81%对87%，P = 0.088）、5年局部失败率（26.2%对14.9%，P = 0.176）、5年远处失败率（14.3%对8.4%，P = 0.371）和5年总生存率（70.7%对78.4%，P = 0.491）无显著差异。HIV阳性患者单因素分析时5年癌症特异性生存率较差（80.5%对93.8%，P = 0.029）但多因素分析时无差异（P = 0.276）。
在CART时代，HIV阳性和HIV阴性肛门癌患者在接受标准放化疗后的耐受性和临床结局相似。
