Vaziri Tina, Rao Yuan J, Whalen Michael, Bethony Jeffrey, Lin Jianqin, Goyal Sharad
Departments of Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC.
Departments of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC.
Adv Radiat Oncol. 2022 Sep 21;8(1):101074. doi: 10.1016/j.adro.2022.101074. eCollection 2023 Jan-Feb.
A consensus has not been reached regarding the treatment and outcomes of prostate cancer (PCa) in people living with HIV/AIDS (PLWHA). This systematic review aims to summarize the evidence on the management of PCa with radiation therapy (RT) in PLWHA diagnosed with PCa.
Searches were conducted in the PubMed, Cochrane Library, and Scopus databases during September 2021 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Articles reporting on outcomes of PLWHA treated for PCa with definitive RT were sought for inclusion.
A total of 9 studies with 187 patients with HIV who received diagnoses of PCa met inclusion criteria. The duration of HIV infection to PCa diagnosis ranged from 8.5 to 18.6 years with 69% to 100% of patients on highly active antiretroviral therapy at the time of diagnosis. Patients' prostate-specific antigen levels ranged from 8 to 82 ng/mL. The majority of patients (59%) were treated with external beam RT, followed by brachytherapy (20.5%). The 4- or 5-year biochemical failure-free rate was reported to be between 87% and 97% in 3 studies, and 2 studies reported an 84% to 97% 5-year cancer-specific survival. Using Common Terminology Criteria for Adverse Events criteria, 3 studies reported toxicities and grade 3 toxicity was observed in only 2 patients.
RT is efficacious and well tolerated in PLWHA as supported by the comparable biochemical control, clinical outcome, and mortality to the general population as well as by the mild reports of radiotoxicity. There is mixed evidence regarding the effect of RT on CD4 count and viral load, and further studies are needed to better understand this relationship. These findings support the use of definitive RT in PLWHA with PCa.
关于人类免疫缺陷病毒/获得性免疫综合征（HIV/AIDS）患者前列腺癌（PCa）的治疗及预后，尚未达成共识。本系统评价旨在总结已确诊PCa的HIV/AIDS患者接受放射治疗（RT）管理的相关证据。
2021年9月，依据系统评价与Meta分析的首选报告项目（PRISMA）标准，在PubMed、Cochrane图书馆及Scopus数据库中进行检索。纳入报告接受根治性RT治疗PCa的HIV/AIDS患者预后的文章。
共有9项研究、187例确诊PCa的HIV患者符合纳入标准。从HIV感染到PCa诊断的时间为8.5至18.6年，69%至100%的患者在诊断时接受高效抗逆转录病毒治疗。患者的前列腺特异性抗原水平为8至82 ng/mL。大多数患者（59%）接受外照射RT治疗，其次是近距离放射治疗（20.5%）。3项研究报告4年或5年无生化失败率在87%至97%之间，2项研究报告5年癌症特异性生存率为84%至97%。根据不良事件通用术语标准，3项研究报告了毒性反应，仅2例患者观察到3级毒性。
RT在HIV/AIDS患者中有效且耐受性良好，生化控制、临床结局和死亡率与普通人群相当，且放射毒性报告轻微，均支持这一结论。关于RT对CD4细胞计数和病毒载量的影响，证据不一，需要进一步研究以更好地理解这种关系。这些发现支持对已确诊PCa的HIV/AIDS患者使用根治性RT。
