Factors Affecting Clinical Outcomes Among Patients Infected With HIV and Anal Cancer Treated With Modern Definitive Chemotherapy and Radiation Therapy
Neil T. PfisterYichun CaoAshely J. SchlafsteinJeffrey M. SwitchenkoPretesh PatelMark W. McDonaldSibo TianJerome C. LandryOlatunji B. AleseClifford GunthelJolinta Y. Lin
1
Citation
37
Reference
10
Related Paper
Citation Trend
Abstract:
PurposeAnal cancer affects a disproportionate percentage of persons infected with human immunodeficiency virus (HIV). We analyzed a cohort of patients with HIV and anal cancer who received modern radiation therapy (RT) and concurrent chemotherapy to assess whether certain factors are associated with poor oncologic outcomes.Patients and MethodsWe performed a retrospective chart review of 75 consecutive patients with HIV infection and anal cancer who received definitive chemotherapy and RT from 2008 to 2018 at a single academic institution. Local recurrence, overall survival, changes in CD4 counts, and toxicities were investigated.ResultsMost patients were male (92%) with large representation from Black patients (77%). The median pretreatment CD4 count was 280 cells/mm3, which was persistently lower at 6 and 12 months’ posttreatment, 87 cells/mm3 and 182 cells/mm3, respectively (P < .001). Most (92%) patients received intensity modulated RT; median dose was 54 Gy (Range, 46.8-59.4 Gy). At a median follow-up 5.4 years (Range, 4.37-6.21 years), 20 (27%) patients had disease recurrence and 10 (13%) had isolated local failures. Nine patients died due to progressive disease. In multivariable analysis, clinically node negative involvement was significantly associated with better overall survival (hazard ratio, 0.39; 95% confidence interval, 0.16-1.00, P = .049). Acute grade 2 and 3 skin toxicities were common, at 83% and 19%, respectively. Acute grade 2 and 3 gastrointestinal toxicities were 9% and 3%, respectively. Acute grade 3 hematologic toxicity was 20%, and one grade 5 toxicity was reported. Several late grade 3 toxicities persisted: gastrointestinal (24%), skin (17%), and hematologic (6%). Two late grade 5 toxicities were noted.ConclusionsMost patients with HIV and anal cancer did not experience local recurrence; however, acute and late toxicities were common. CD4 counts at 6 and 12 months’ posttreatment remained lower than pretreatment CD4 counts. Further attention to treatment of the HIV-infected population is needed.Objective:To investigate the clinical features in patients with NKTLNT,the treatment response between radiotherapy as initial treatment and chemotherapy as initial treatment,and the influence of different therapy on 5-year survival.Methods:The deta of 57 patients with Ann Arbor stage IE NKTLNT who underwent radiotherapy+chemotherapy,or chemotherapy+radiotherapy,were retrospectively reviewed.These patients were divided into two groups according to initial treatment:radiotherapy alone or radiotherapy+chemotherapy group(n=35 patients) and a chemotherapy+radiotherapy group(n=22 patients).The treatment response,and survival data for the patients were compared between this two groups.Results:There was no significant difference in the clinical profiles between the two groups.26 patients(74%) in the radiotherapy plus chemotherapy group achieved complete response after initial treatment,whereas only 5 patients(23%) in the chemotherapy plus radiotherapy group achieved complete response.But Compared with the patients in the chemotherapy+radiotherapy group,those in the radiotherapy+chemotherapy group had a similar 5-year overall survival rate(61.9% for the radiotherapy+chemotherapy group vs.55% for the chemotherapy+radiotherapy group).Conclusions:NKTLNT do not have specific symptoms which can help for early-stage diagnosis,and radiotherapy as initial treatment can achieve better treatment response,but our research does not get an increased 5-year overall survival rate in the radiotherapy+ chemotherapy group.
Cite
Citations (0)
Blood stasis syndrome,which commonly exists in patients with malignant tumor,is not only a objective sign in cancer,but also plays an important role in the growth,invasion and metastasis of malignant tumor. Operation,radiotherapy and chemotherapy are the main treatments of cancer and all of these three treatments can reduce the tumor and relieve the symptoms.Therefore,operation,radiotherapy and chemotherapy can ease the patients' blood stasis state to a certain extent. However,operation,radiotherapy and chemotherapy may cause some damage to the body and can effect the stasis syndrome in the different time of treatment process. So,operation,radiotherapy and chemotherapy may have the potential promote to the invasion and metastasis of malignant tumor through effect the blood stasis state. Therefore,using blood-activating herbs in the different time of operation,radiotherapy and chemotherapy may have different effects on the tumor invasion and metastasis.
Blood stasis
Cite
Citations (0)
Objective To retrospectively analyze and evaluate the outcome of malignant cerebral glioma treated by chemotherapy plus radiotherapy.Methods A total of 126 patients with malignant cerebral glioma were retrospectively studied.Sixty-four patients in the radiotherapy group were irradiated with DT54-60 Gy,62 patients in the chemotherapy plus radiotherapy group were given chemotherapy(VM-26 and Me-CCNU)after exposure to DT 20 Gy.The 1-,3-and 5-year survival rates of these patients were compared.Results The 1-,3-,and 5-year survival rates of the radiotherapy group were 64.06%,31.25%,and 15.63% respectively,while the 1-,3-,and 5-year survival rates of the chemotherapy plus radiotherapy group were 80.65%,50%,and 30.65 % respectively(P 0.05).Conclusion Combination of chemotherapy and radiotherapy is effective and well-tolerated in the treatment of malignant cerebral glioma.
Cite
Citations (1)
Radiotherapy is the usual nonsurgical treatment for anal cancer. This multicenter study from the UK examined whether adding chemotherapy to radiotherapy improves outcome.
Researchers randomized 585 patients with anal cancer to receive radiotherapy either with …
Cite
Citations (0)
Anal cancer accounts for only 1.5% of  gastrointestinal malignancies but this disease has shown a steady increase in incidence particularly in HIV positive males. The understanding of pathophysiology and treatment of anal cancer has changed radically over last thirty years . Risk factors have been identified and organ preservation by chemoradiotherapy has become a standard. This article aims to review  the clinical presentation, diagnostic evaluation, and treatment options for anal cancer in the light of current literature . Key words : anal cancer, anal canal, anal margin, chemoradiotherapy, HIV, HPV, salvage, recurrence, imaging.
Chemoradiotherapy
Anal Carcinoma
Presentation (obstetrics)
Cite
Citations (0)
Breast cancer is one of the most common malignancies in women worldwide. It can be treated with surgery combined with chemotherapy and radiotherapy.This study aims to investigate the effects of chemotherapy and radiation therapy on blood cell components of breast cancer patients who survived one of these therapies, in Al-Amal National Hospital for Cancer Management. Numbers of blood cells including white blood cell (WBC), red blood cell (RBC) and lymphocytes, and hemoglobin (HGB) concentration were measured in thirty-two women with eighteen of them treated with chemotherapy and the left treated with radiotherapy.The results showed that the counts of WBC, RBC and lymphocytes decreased faster in the patients treated with chemotherapy compared to that in the patients treated with radiotherapy, whereas HGB concentrations only slightly changed with both treatments, upon four cycles of each treatment. These results support that radiotherapy may cause less side effects on breast cancer patients compared to chemotherapy.
White blood cell
Cite
Citations (2)
Anal cancer incidence is elevated among HIV-infected individuals, especially men who have sex with men (MSM). However, no national guidelines exist for anal cancer screening or treatment of precancerous anal lesions, in part because data are lacking on progression of anal intraepithelial neoplasia (AIN) to anal cancer. To explore this issue, researchers in Australia reviewed the records of 574 patients (95% MSM, 73% …
Anal sex
Cite
Citations (0)
Induction chemotherapy, followed by surgery and/or radiotherapy was utilized in patients with advanced squamous cell carcinoma of the head and neck. During these trials, the authors observed that response to chemotherapy predicts further response to subsequent radiotherapy. This study was comprised of 57 patients with 60 separate neoplasms who demonstrated less than complete response (partial or no response) to initial treatment with a combination chemotherapy containing cisplatin. Subsequently radiotherapy, either 5000 rad preoperatively or 6600 rad as definitive therapy, was employed. Forty-one of the 42 tumors with initial partial response to chemotherapy also responded to radiotherapy (97.6%). Only one of the 18 tumors that initially failed to respond to chemotherapy subsequently responded to radiotherapy (5.5%). This observation suggests that patients with head and neck cancer sensitive to initial chemotherapy share parameters that are also radiation sensitive.
Induction chemotherapy
Epidermoid carcinoma
Complete response
Cite
Citations (277)
Until now, the possibility of radiotherapeutic treatment after a failure of chemotherapy has not been systematically investigated. Eight cases with primary failure of chemotherapy or recurrence after chemotherapy could be evaluated. The patients were submitted to curative irradiation; six of them achieved a total remission, four had recurrences. Thus two patients remain to give an example that radiotherapy can bring about long-term total remissions after primary failure of chemotherapy or recurrence after chemotherapy. When the data were evaluated, the total remission times of the two patients were 12 and 18 months, respectively. The toxicity of radiotherapy was justifiable. It was increased especially in regions that had already been irradiated or if a ABVD therapy was applied a short time before or after the radiotherapy. There are only few communications in literature about the success of a radiotherapy after failure of chemotherapy. Most of the patients mentioned had "remissions" (total/partial remissions?). In most of the cases, there are no indications about the further development. On the whole, the data show that there may be some special indications for radiotherapy in case of a failure of chemotherapy.
ABVD
Cite
Citations (0)
Objective:To study the changes of platelet parameter in tumor patients before or after radiotherapy and chemotherapy and the clinic significance.Methods: 31 cases of tumor patients before or after radiotherapy and chemotherapy were selected and their platelet parameters(PLT,PCT,MPV,DPW,P-LCR) were measured by the sysmex SF-3000 complete automatic hemanalysis, then compared with control group.Results: There was no signficant difference between the two groups in the platelet parameters before radiotherapy and chemotherapy(P0.05).The levels of PLT,PCT,MPV,P-LCR in tumor patients after radiotherapy and chemotherapy were significantly lower than that before radiotherapy and chemotherapy(P0.01或P0.05),but PDW is no different(P0.05).Conclusion:Determine of platelet parameters of tumor patients before or after radiotherapy and chemotherapy is of certain clinical significance for observation of the status of their marrow restrained and estimate of state of illness.
Cite
Citations (0)