Epidermoid anal cancer in HIV-infected patients (Meeting abstract).

Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.

Epidermoid anal cancer in HIV-infected patients (Meeting abstract).

Br J Cancer; 70(Suppl 22):17 1994. Unique Identifier : AIDSLINE ICDB/95611642
Bottomley D; Gershuny A; Govindaraju S; Phillips RH; Department of Radiotherapy, Charing Cross Hospital, London W6, UK

Abstract: Anal cancer is un uncommon malignancy but it appears to occur at an increased frequency in homosexual men who partake in receptive anal intercourse. The human immunodeficiency virus (HIV) has not been shown to be an independent risk factor in anal carcinoma since in population cohorts of intravenous drug abusers and hemophiliacs anal carcinoma is rare. However, there is evidence to suggest that HIV may modify the natural history of anal carcinoma in those subjects at risk of developing it. Furthermore, the limited clinical evidence that exists, suggests that these patients have a very poor outcome. We treated 5 HIV+ homosexual men between 1989 and 1993 with histologically confirmed epidermoid anal carcinoma. Their mean age was 45 (range 41-49). Four patients had symptomatic HIV infection at time of diagnosis and one of those had full-blown AIDS. Patients were tested for the HIV antibody a mean 30 months (range 0-62) before presentation of anal carcinoma. The mean CD4 cell count at diagnosis was 251/mm3 (5-399). Pre-existing anal warts were absent in all patients. Presenting complaints were anal discharge (4 patients), anorectal pain (3), PR bleeding (2), tenesmus (1) and perianal rash (1). UICC staging revealed 1 stage III, 2 stage II and 2 stage I tumors. Histology revealed 2 poorly diff and 1 mod diff squamous tumors and 2 basaloid squamous tumors. Diagnostic biopsy in all cases was followed by radiotherapy alone (1 patient declined chemotherapy) or radiotherapy and chemotherapy combined (4 patients). A combination of mitomycin-c (10 mg to 7.5 mg/m2) iv bolus on day 1 and 5-FU (1000 mg to 750 mg/m2/day) ivi (days 1-4) given during the first week of radiotherapy. The patient with stage III disease also received 5-FU 1000 mg/day for 4 days during the 5th week of radiotherapy. All patients with stage III disease also received 5-FU 1000 mg/day for 4 days during the 5th week of radiotherapy. All patients received pelvic radiotherapy using schedules of 45 Gy (25 fx/5 wk; 2 pts), 46.8 Gy (26 fx/8 wk; included a 3 wk cap), 50 Gy (28 fx) followed by a reduced volume boost of 18 Gy (10 fx) over 88 days (included gaps totaling 5 wk) for the patient with stage III disease, and 40 Gy (20 fx/14 wk) followed after 3 months by a boost of 20 Gy (10 fx/2 wk) for the patient who declined chemotherapy. Treatment was associated with perineal skin reactions in all patients which forced delays of 2, 20 and 35 days in 3 patients, the patient with the stage III tumor died 9 months after diagnosis with recurrent anal carcinoma. The patient with AIDS and CD4 count of 5/mm3 died 3 months after diagnosis with AIDS encephalopathy. The other 3 patients remain disease free 8, 40 and 59 months from diagnosis. One of these patients who has confirmed radiation proctitis has long-standing diarrhea which preceded his tumor by 1 year. Epidermoid anal carcinoma in HIV(+) patients can be managed successfully using combined chemoradiotherapy, although acute toxicity may be severe.

Keywords: Adult Anus Neoplasms/DRUG THERAPY/*ETIOLOGY/RADIOTHERAPY Carcinoma, Squamous Cell/*COMPLICATIONS/DRUG THERAPY/RADIOTHERAPY Fluorouracil/ADMINISTRATION & DOSAGE Human HIV Infections/*COMPLICATIONS Male Middle Age ABSTRACT

951130
M95B0955

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