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Invasive Anal Squamous-Cell Carcinoma in the HIV-Positive Patient: Outcome in the Era of Highly Active Antiretroviral Therapy

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Introduction

The incidence of invasive anal squamous-cell carcinoma in patients with HIV is increasing. We report the outcome after combined chemoradiotherapy for anal squamous-cell carcinoma in HIV-infected individuals.

Methods

Thirty-two HIV-positive patients treated at the St. Vincent’s Cancer Care Center for anal squamous-cell carcinoma from 1997 through mid 2005 were reviewed retrospectively. All patients also received highly active antiretroviral therapy. Treatment consisted of radiotherapy concurrent with 5-fluorouracil and mitomycin C in most patients. Overall survival, anal cancer-specific survival, local recurrence, and toxicity were assessed.

Results

Median time from completion of radiotherapy to last follow-up of surviving patients was 35 months. Five-year locoregional relapse, anal cancer-specific survival, and overall survival were 16 , 75, and 65 percent, respectively. In multivariate analysis, locoregional recurrence, cancer-specific survival, and overall survival were all significantly associated with tumor size. Overall survival was independently associated with high viral load and low CD4 count. Acute toxicity included: Grade 3 skin in 25 percent of patients, Grade 3 diarrhea: 28 percent, and Grade 3 or 4 hematologic toxicity in 21 and 48 percent, respectively. More than two-thirds of patients required radiotherapy interruption. There was no negative impact of chemoradiotherapy on viral load.

Conclusions

Outcome after chemoradiotherapy for HIV-related anal squamous-cell carcinoma in the era of highly active antiretroviral therapy is comparable to outcome in patients without HIV. However, significant toxicity is seen with standard treatment regimens. Earlier diagnosis and risk-adapted therapy could lead to improved survival and decreased treatment-related morbidity.

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Authors and Affiliations

  1. Department of Medicine, St. Vincent’s Hospital, New York, New York, United States

    Ann Wexler M.D. & Roger Waltzman M.D.

  2. Department of Radiation Oncology, St. Vincent’s Hospital, New York, New York, United States

    Anthony M. Berson M.D., Olivier G. Maisonet F.N.P., O.C.N., Bill McDermott L.M.S.W. & John Rescigno M.D.

  3. Department of Surgery, Mt. Sinai School of Medicine, New York, New York, United States

    Stephen E. Goldstone M.D.

  4. Department of Surgery, St. Vincent’s Hospital, New York, New York, United States

    Jason Penzer M.D.

Authors
  1. Ann Wexler M.D.
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  2. Anthony M. Berson M.D.
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  3. Stephen E. Goldstone M.D.
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  4. Roger Waltzman M.D.
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  5. Jason Penzer M.D.
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  6. Olivier G. Maisonet F.N.P., O.C.N.
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  7. Bill McDermott L.M.S.W.
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  8. John Rescigno M.D.
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Corresponding author

Correspondence to John Rescigno M.D..

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.

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Wexler, A., Berson, A.M., Goldstone, S.E. et al. Invasive Anal Squamous-Cell Carcinoma in the HIV-Positive Patient: Outcome in the Era of Highly Active Antiretroviral Therapy. Dis Colon Rectum 51, 73–81 (2008). https://doi.org/10.1007/s10350-007-9154-7

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  • DOI: https://doi.org/10.1007/s10350-007-9154-7

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