Feasibility and Outcome of Routine Use of Concurrent Chemoradiation in HIV-positive Patients with Squamous Cell Anal Cancer

Andrew J. Leiker, Chiachien J. Wang, Nina N. Sanford, Todd A. Aguilera, Sirisha Karri, Muhammad S Beg, Syed A. Kazmi, Craig Olson, Joselin A. Matthews, Abier A Abdelnaby, Jeffrey J Meyer, Michael R Folkert

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives:Clinical concerns about hematologic toxicities in human immunodeficiency virus (HIV)+ patients with squamous cell anal cancer (SCAC) may lead to de-escalation of treatment intensity. The objective of this study is to evaluate clinical outcomes including toxicity following standard concurrent curative-intent chemoradiation for HIV+ and HIV-patients with SCAC.Materials and Methods:Among 97 evaluable patients treated between 2009 and 2016 (median age 52.2 y), 43 (44.3%) were HIV+ and 54 (55.7%) HIV-. The majority of the radiation was delivered using intensity-modulated radiation therapy and chemotherapy consisting primarily (93%) of 5-fluorouracil and mitomycin C. Clinical outcomes assessed included toxicity, locoregional control (LRC), distant metastasis (DM), progression-free survival (PFS), colostomy-free survival (CFS), overall survival (OS), and cause-specific survival (CSS).Results:With a median follow-up of 45 months, HIV+ patients exhibited a trend toward reduced OS compared with HIV-patients (4 y OS 61.2% vs. 78.3%; HR 2.09; 95% CI, 0.97-4.52; P=0.055) on univariable analysis, but HIV status was not significant after adjusting for additional parameters on multivariable analysis. Toxicity rates, LRC, CFS, PFS, freedom from DM, and CSS were similar between the 2 cohorts. On multivariable analysis, tumor size >5 cm impacted all clinical outcomes (trend for LRC) except CFS. Radiation treatment extension beyond 7 days was found to negatively impact LRC and CSS. Male sex was associated with worse CFS.Conclusions:Radiation therapy with concurrent 5-fluorouracil and mitomycin C chemotherapy is reasonably well-tolerated as curative treatment for HIV+ patients with SCAC, and no significant difference in outcomes was noted relative to HIV-patients.

Original languageEnglish (US)
Pages (from-to)701-708
Number of pages8
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Issue number10
StatePublished - Oct 1 2020


  • anal cancer
  • concurrent chemoradiation
  • human immunodeficiency virus (HIV)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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