Efficacy and toxicity of chemoradiation in the treatment of HIV-associated anal cancer

Purpose: The purpose of this retrospective study is to determine the results and the toxicity of concurrent chemoradiation for squamous cell carcinoma of the anal canal in HIV-positive patients treated at a single institution. Patients and Methods: HIV-positive patients with squamous cell carcinoma of the canal treated at Continuum Cancer Centers-affiliated hospitals were identified from tumor registries. We reviewed hospital and treatment charts to gather data relating to demographics, HIV status including cluster of differentiation 4 (CD4) count and viral load, tumor stage, radiation and chemotherapy treatment, toxicity and local control, and survival. Results: Thirty-four patients were identified. All patients received radiation and concurrent chemotherapy consisting of either mitomycin-C and 5-fluorouracil (5-FU; 20 patients), cisplatin and 5-FU (13 patients), or 5-FU alone (1 patient). The most frequently reported severe toxicities were dermatologic (50% grade 3 or 4 toxicity) and hematologic (36% grade 3 or 4 toxicity). Actuarial local control and overall survival (OS) at 3 years were 63% and 69%, respectively. Conclusion: Concurrent chemoradiation with cisplatin or mitomycin and 5-FU in HIV-positive patients provides local control and OS comparable to that observed in the HIV-negative population, with acceptable toxicity.