Abstract
PURPOSE: Patients diagnosed as having anal cancer and human immunodeficiency virus (HIV)-positive disease were evaluated for response to treatment and its associated toxicity. METHODS: We studied nine HIV-positive patients with squamous-cell carcinoma of the anus. Among them, three patients had acquired immunodeficiency syndrome (AIDS). The stage of disease at presentation included: one Stage 0, two Stage I, two Stage II, and four Stage III patients. Seven patients received combined modality treatment,i.e.,radiation therapy and chemotherapy, and two patients received radiation therapy alone. The radiation therapy field included the pelvis and a conedown boost. Chemotherapy consisted of two cycles of 5-fluorouracil and mitomycin C. Patients have been followed from 2 to 42 (median, 8) months. RE-SULTS: Seven patients achieved a complete response clinically. All Stage I/II patients and one of four Stage III patients remain alive and have no evidence of disease. Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer Grades 3 and 4 skin toxicity were noted in six patients, and Grades 2 and 3 myelosuppression were noted in eight patients. The response rates achieved are comparable to the experience in non-HIV patients reported in the literature, but toxicity seems to be increased. CONCLUSION: It would seem reasonable to offer combined modality treatment to early stage, HIV-positive patients with good performance status and a history of minor opportunistic infections. The value of combined modality in AIDS patients and those who present with advanced stages of the disease is questionable.
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References
New York City Department of Health AIDS Surveillance. The AIDS epidemic in NYC, 1981–1984. Am J Epidemiol 1986;123:1013–5.
Daling JR, Weiss NS, Hislop TG,et al. Sexual practices, sexually transmitted diseases and the incidence of anal cancer. N Engl J Med 1987;317:973–7.
Rudlinger R, Buchmann P. HPV-16 positive Bowenoid papulosis and squamous-cell carcinoma of the anus in an HIV-positive man. Dis Colon Rectum 1989;32:1042–5.
Cooper HS, Patchefsky AS, Marks G. Cloacogenic carcinoma of the anorectum in homosexual men: an observation of four cases. Dis Colon Rectum 1979;22:557–8.
Leach RD, Ellis H. Carcinoma of the rectum in male homosexuals. J R Soc Med 1981;74:490–1.
Daling JR, Weiss NS, Klopfenstein LL. Correlates of homosexual behavior and the incidence of anal cancer. JAMA 1982;247:1988–90.
Crombleholme T, Schecter W, Wilson W. Anal carcinoma: changes in incidence, natural history and treatment [abstract]. Proc Am Soc Clin Oncol 1989;8:A13.
Nigro ND. An evaluation of combined therapy for squamous-cell cancer of the anal canal. Dis Colon Rectum 1984;27:763–6.
Sichy B. The use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anus and marginally resectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 1985;11:1587–93.
Flam MS, John M, Lovalvo LJ,et al. Definitive nonsurgical therapy for epithelial malignancies of the anal canal. Cancer 1983;51:1378–87.
Cummings BJ, Harwood AR, Keane TJ, Rider WD, Thomas GM. Anal canal carcinoma: improving the therapeutic ratio with combined radiation and chemotherapy [abstract]. Int J Radiat Oncol Biol Phys 1983;9:110.
John MJ, Flam M, Lovalvo L, Mowry PA. Feasibility of nonsurgical definitive management of anal cancer. Int J Radiat Oncol Biol Phys 1987;13:299–303.
DeVita VT Jr, Hellman S, Rosenberg SA. Cancer: principles & practice of oncology, 4th ed. Philadelphia: JB Lippincott, 1993:1006–22.
Michaelson RA, Magill GB, Quan SH,et al. Preoperative chemotherapy and radiation therapy in the management of anal epidermoid carcinoma. Cancer 1983;51:390–5.
Flam MS, John MJ, Mowry PA,et al. Definitive combined modality therapy of carcinoma of the anus. Dis Colon Rectum 1987;30:495–502.
Byfield JE, Barone RM, Sharp TR. Conservative management without alkylating agents of squamous cell anal cancer using cyclical 5-FU alone and with x-ray therapy. Cancer Treat Rep 1983;67:709–12.
Cummings BJ, Keane TJ, Thomas G, Harwood A, Rider W. Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy. Cancer 1984;54:2062–8.
Cummings BJ, Keane TJ, O'Sullivan B, Wong CS, Catton CN. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys 1991;21:1115–25.
Papillon J, Montbarbon JF. Epidermoid carcinoma of the anal canal: a series of 276 cases. Dis Colon Rectum 1987;30:324–32.
Hughes LL, Rich TA, Delclos L, Ajani JA, Martin RG. Radiotherapy for anal cancer: experience from 1979–1987. Int J Radiat Oncol Biol Phys 1989;17:1153–60.
Kaplan LD. AIDS-associated non-Hodgkin's lymphoma. Curr Opin Oncol 1989;1:62–7.
Cooper JS, Fried PR, Laubenstein LJ. Initial observations on the effect of radiotherapy on epidemic Kaposi's sarcoma. JAMA 1987;252:934–5.
Rotman M, Lange CS, Phil D. Anal cancer: radiation and concomitant continuous infusion chemotherapy. Int J Radiat Oncol Biol Phys 1991;21:1385–8.
Lorenz HP, Wilson W, Leigh B, Crombleholme T, Schecter W. Squamous-cell carcinoma of the anus and HIV infection. Dis Colon Rectum 1991;34:336–8.
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Chadha, M., Rosenblatt, E.A., Malamud, S. et al. Squamous-cell carcinoma of the anus in HIV-positive patients. Dis Colon Rectum 37, 861–865 (1994). https://doi.org/10.1007/BF02052589
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DOI: https://doi.org/10.1007/BF02052589