JCO Early Release, published online ahead of print Apr 21 2008
Journal of Clinical Oncology, 10.1200/JCO.2007.15.2348
Received November 8, 2007
Accepted February 11, 2008
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, and 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.
* To whom correspondence should be addressed. 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 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. Radiotherapy (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-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 a 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.
