Originally published as JCO Early Release 10.1200/JCO.2007.15.2348 on April 21 2008

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HIV-Specific Differences in Outcome of Squamous Cell Carcinoma of the Anal Canal: A Multicentric Cohort Study of HIV-Positive Patients Receiving Highly Active Antiretroviral Therapy

Christoph Oehler-Jänne, Florence Huguet, Sawyna Provencher, Burkhardt Seifert, Laura Negretti, Marc-Oliver Riener, Marta Bonet, Abdelkarim S. Allal, I. Frank Ciernik

From the Department of Radiation Oncology, Pathology, and the Center for Clinical Research Zurich University Hospital; Department for Social- and Preventive Medicine, Biostatistics, University of Zurich, Zurich; Division of Radiation Oncology, University Hospital of Geneva, Geneva; Oncology Institute of Southern Switzerland, Ospedale San Giovanni e Valli, Bellinzona, Switzerland; Department of Radiation Oncology, Tenon Hospital, Université Pierre et Marie Curie (Paris), Assistance Publique-Hôpitaux de Paris, Paris, France; and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montréal, Québec, Canada

Corresponding author: I.F. Ciernik, MD, Istituto Oncologico della Svizzera Italiana (IOSI), Ospedale San Giovanni e Valli, 6500 Bellinzona; e-mail: ciernik{at}iosi.ch

Purpose: To define clinical outcome after definitive chemoradiotherapy (CRT) of anal carcinoma in HIV-infected patients treated with highly active antiretroviral therapy (HAART).

Patients and Methods: A multicentric cohort comparison of 40 HIV-positive patients with HAART and 81 HIV-negative patients treated with radiotherapy (RT) or CRT was retrospectively performed. Local disease control (LC), relapse-free survival (RFS), overall survival (OS), cancer-specific survival (CSS), toxicity, and prognostic factors were investigated.

Results: HIV-positive patients were younger (mean age, 48 v 62 years; P < .0005), predominantly male (93% v 25%; P < .0005), and with early-stage (P = .06) and large-cell histology (90% v 67%; P = .005) disease. RT or CRT resulted in complete response in 92% (HIV positive) and 96% (HIV negative) of cases. Five-year OS was 61% (95% CI, 44% to 78%) in HIV-positive and 65% (95% CI, 53% to 77%) in HIV-negative patients (median follow-up, 36 months). Five-year LC was 38% (95% CI, 5% to 71%) in HIV-positive and 87% (95% CI, 79% to 95%) in HIV-negative patients (P = .008) compromising CSS and sphincter preservation. Grade 3/4 acute skin (35% v 17% [HIV negative]; P = .04) and hematologic (33% v 12% [HIV negative]; P = .08) toxicity together approximated 50% in HIV-positive patients. RFS in HIV-positive patients was associated with RT dose (P = .08) and severe acute skin toxicity (P = .04).

Conclusion: Long-term LC and acute toxicity represent major clinical challenges in HIV-positive patients with anal carcinoma. Even if fluoropyrimidine-based CRT is feasible and may result in similar response rates and OS as in HIV-negative patients, improved treatment strategies with better long-term outcome are warranted.

Supported in part by the Radium Fund of the University of Zurich, Zurich, Switzerland and unrestricted grants from Merck Sharp Dome Inc. and Abbott Laboratories Inc. (I.F.C.).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

published online ahead of print at www.jco.org on April 21, 2008.