Effect of CD4 Count on Treatment Toxicity and Tumor Recurrence in Human Immunodeficiency Virus–Positive Patients With Anal Cancer

Bryant, Alex K.; Mudgway, Ross; Huynh‐Le, Minh‐Phuong; Simpson, Daniel R.; Mell, Loren K.; Gupta, Samir; Sharabi, Andrew B.; Murphy, James D.

doi:10.1016/j.ijrobp.2017.09.034

Cited by 17 publications

(15 citation statements)

References 28 publications

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“…Demonstration of worse FFLR in HIV‐positive patients with low CD4 counts after treatment is not without precedence. A recent database analysis of 142 HIV‐positive patients found that post‐treatment CD4 count, and not pretreatment, was associated with a 54% increased risk of recurrence for every 100 cells per mm 3 decrease . Similarly, the current study found that post‐treatment CD4 count less than 150 cells per mm 3 resulted in a significantly worse OS among HIV‐positive patients ( p = .015), whereas pretreatment CD4 count was not significantly associated.…”

Section: Discussionsupporting

confidence: 58%

“…Even with these demographic differences, HIV‐positive patients were found to have similar T and N stage as HIV‐negative patients, with the majority having early stage disease. Regardless of the similarity of the baseline characteristics, multiple prior investigations have recognized worse FFLR and OS for HIV‐positive patients treated definitively for ASCC . In this series, HIV‐positive patients tended to have a FFLR more similar to HIV‐negative patients with one higher T‐stage (i.e., FFLR for HIV‐positive/T1 being similar to HIV‐negative/T2).…”

Section: Discussionmentioning

confidence: 70%

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Factors Impacting Differential Outcomes in the Definitive Radiation Treatment of Anal Cancer Between HIV-Positive and HIV-Negative Patients

et al. 2020

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Background Anal squamous cell carcinoma (ASCC) is uncommon, yet seen more frequently in the setting of the human immunodeficiency virus (HIV). Chemoradiotherapy is the definitive modality of treatment for patients with ASCC; this study examines factors impacting clinical outcomes in a large cohort of HIV‐positive and HIV‐negative patients. Methods A retrospective review was conducted of patients treated for nonmetastatic ASCC at a single institution between 2005 and 2018. Freedom from local recurrence (FFLR), freedom from distant metastasis, and overall survival (OS) were calculated using the Kaplan‐Meier method, and univariate and multivariate analysis were performed using the Cox proportional hazards model. Results During the study period, 111 patients initiated definitive treatment for ASCC. Median age of the entire cohort was 56.7 years (interquartile range, 51.5–63.5), with 52 patients (46.8%) being HIV‐positive. At median follow‐up of 28.0 months, the 2‐ and 5‐year FFLR were 78.2% (95% confidence interval [CI], 70.4–87.0) and 74.6% (95% CI, 65.8–84.5), respectively. Multivariate analysis revealed time from diagnosis to treatment initiation (median, 8 weeks; hazard ratio, 1.06; 95% CI, 1.03–1.10) to be significantly associated with worse FFLR and OS. HIV‐positive patients had a trend toward worse FFLR (log‐ranked p = .06). For HIV‐positive patients with post‐treatment CD4 less than 150 cells per mm3, there was significantly worse OS (log‐ranked p = .015). Conclusion A trend toward worse FFLR was seen in HIV‐positive patients, despite similar baseline disease characteristics as HIV‐negative patients. Worse FFLR and OS was significantly associated with increased time from diagnosis to treatment initiation. Poorer OS was seen in HIV‐positive patients with a post‐treatment CD4 count less than 150 cells per mm3. Implications for Practice Human immunodeficiency virus (HIV)‐positive patients with anal squamous cell carcinoma can represent a difficult clinical scenario. Definitive radiation with concurrent chemotherapy is highly effective but can result in significant toxicity and a decrease in CD4 count that could predispose to HIV‐related complications. As HIV‐positive patients have largely been excluded from prospective clinical trials, this study seeks to provide greater understanding of their outcomes with radiation therapy, potential predictors of worse local control and overall survival, and those most at risk after completion of treatment.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 70%

Factors Impacting Differential Outcomes in the Definitive Radiation Treatment of Anal Cancer Between HIV-Positive and HIV-Negative Patients

et al. 2020

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“…[19] In patients with HIV, insufficiency of glutathione (GSH) could lead to the depletion of radioprotective thiols and increased oxidative stress. A study by Alex et al [20] reported that HIV patients who are affected via anal cancer and have a CD4 test outcome of fewer than 200 have increased mucositis and bleeding and decreased tolerance suggesting a high requirement for lower remedy doses. [20]…”

Section: Methodsmentioning

confidence: 99%

“…A study by Alex et al [20] reported that HIV patients who are affected via anal cancer and have a CD4 test outcome of fewer than 200 have increased mucositis and bleeding and decreased tolerance suggesting a high requirement for lower remedy doses. [20]…”

Section: Methodsmentioning

confidence: 99%

Management of radiation-induced proctitis

Porouhan

Farshchian

Dayani

2019

J Family Med Prim Care

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The occurrence of chronic proctitis as a side effect among radiotherapy patients is about 5%. Radiation proctitis and consequent development of chronic proctitis are not associated to each other. However, a lot of samples of proctitis that are limited easily could be treated by typical remedial techniques. Improvements in radiotherapy techniques that make possible the delivery of superior doses of radiation could easily reduce both chronic and acute proctitis. The step-by-step remedial procedure for treatment of this disorder starts with conservative remedial management and includes iron substitution as a second-line therapy. For patients who did not receive initial therapies, sucralfate injection, topical corticosteroids, and antidiarrhea therapy were provided as a means of aggressive care. In cases of continuous rectal bleeding, remedial laser techniques and formaldehyde administration should be attempted before surgical therapy. When surgical therapy is required, a descending or transverse colostomy must be carried out. Advanced methods such as intraperitoneal injections of formalin or novel methods of cold therapy and radiofrequency ablation (RFA) provide a wider remedial field. Exceptionally, unanticipated conclusion of neosquamous wound healing via RFA may have additional preponderances in stopping symptoms and may require better assessment through accurate randomized examination. Since aggressive treatments like coloanal anastomosis and colorectal surgery are correlated with remarkable mortality and morbidity, they must be considered as the final course of remedial treatment.

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“…In malignant diseases, tumour-infiltrating T cells have been associated with prognosis in malignant melanoma [111] and ovarian cancer [112]. In HIV-positive patients with anal cancer, lower CD4+ T cell counts were associated with worse treatment outcome [113]. Similar to CD4+ T cells several reports associate CD8+ T cells with improved survival in different forms of cancer [114,115,116].…”

Section: Project I: Identification Of Shared Disease Genesmentioning

confidence: 99%

Identification of genes and regulators that are shared across T cell associated diseases

Gawel¹

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Effect of CD4 Count on Treatment Toxicity and Tumor Recurrence in Human Immunodeficiency Virus–Positive Patients With Anal Cancer

Cited by 17 publications

References 28 publications

Factors Impacting Differential Outcomes in the Definitive Radiation Treatment of Anal Cancer Between HIV-Positive and HIV-Negative Patients

Factors Impacting Differential Outcomes in the Definitive Radiation Treatment of Anal Cancer Between HIV-Positive and HIV-Negative Patients

Management of radiation-induced proctitis

Identification of genes and regulators that are shared across T cell associated diseases

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