A retrospective review of squamous cell carcinoma of the anal canal in HIV-positive and HIV-negative patients

Abstract

e15586 Background: Human immunodeficiency virus (HIV) infected patients (pts) are at increased risk for squamous cell carcinoma of the anal canal (SCCAC) and the incidence of SCCAC has increased in the era of HAART (highly active antiretroviral therapy). The outcome of SCCAC in HIV (+) pts has not been evaluated in prospective trials and the published literature is limited to small retrospective case series. The aim of this study is to describe the outcome, tolerability, and overall survival (OS) in pts with and without HIV infection treated at Karmanos Cancer Institute, at Wayne State University from 1991 to 2007. Methods: We performed a retrospective chart review. We collected data regarding HIV status, demographics (age, gender, race), stage at diagnosis, treatment, response to treatment, toxicity, and survival. Results: Fifty pts with SCCAC were identified, of whom 18 were HIV (+) and 32 were HIV (−), 26% Caucasians, 68% African American, 56% males and 44% females. HIV (+) pts had significantly better stage (p = 0.011) and less frequent reduced chemotherapy dose (p = 0.001). There were no significant differences by HIV status in type of chemotherapy received, frequency of reduced radiotherapy dosage, use of diverting colostomy, or frequency of relapse. Diverting colostomy was required in 29% of HIV (+) pts and 18% of HIV (−) pts. The major toxicities observed in HIV (+) and (−) pts were diarrhea (36% vs. 64%), neutropenia (27% vs. 21%), and skin toxicity secondary to radiotherapy (XRT: 82% vs. 100%; p = 0.034). Median (OS) was 62.6 months for HIV (+) pts and 71.8 months for HIV (−) pts (p = 0.787). Conclusions: HIV (+) pts had better stage, received standard chemotherapy dose more often, and had more frequent XRT dermatitis than HIV (−) pts. Otherwise, there was no major difference in treatment toxicities. A higher proportion of HIV (+) pts required diverting colostomy. Survival is somewhat shorter among HIV (+) patients. No significant financial relationships to disclose.