Cancer of the Anal Canal and Hiv Infection: Toxicity and Results of Organ Preservation with Radiochemotherapy or Radiotherapy

Background: Anal cancer is an evolving problem in HIV-infected patients. In fear of excessive toxicity in patients with HIV infection, aggressive therapy is often withheld. Patients and Methods: From January 1995 to October 1997, 6 patients with epidermoid cancer of the anal canal and a long history of HIV infection but without symptoms of AIDS or repeated severe infections were treated with radiotherapy (1 patient) or radiochemotherapy (5 patients). External beam radiotherapy with 45 Gy to the tumor and pelvic as well as inguinal lymphatic drainage were administered. An additional small-field boost of 5.4–9 Gy was given in larger tumors or, at the end of the reported time span, to enhance the cumulative dose (1 patient). Chemotherapy consisted of 5-fluorouracil (5-FU) 1000 mg/m2/24 h, days 1–4, two cycles, and mitomycin C either 1 × 15 mg/m2, day 1 in the 1st week, or 2 × 10 mg/m2, day 1 in the 1st and 5th weeks of radiotherapy. Results: Besides one reproducible event of cardiovascular grade 3 toxicity due to 5-FU, acute reactions were mild to moderate in all patients, and all but one radiotherapy treatments could be given as scheduled (1 patient with a delay of 4 days). With a median observation time of 24 (10–44) months, 4 out of 6 patients have their disease controlled, one progressed locally without ever achieving even a partial remission and died of disease, whereas the remaining patient had a local recurrence and distant metastasis at 18 months. Conclusion: Chemoradiation with standard doses of 5-FU and mitomycin C can be offered to patients with HIV infection and cancer of the anal canal who are in good general condition and do not suffer from a compromised immune system. In these patients, side effects and outcome are comparable to those in non-HIV-infected patients.