The significance of pretreatment CD4 count on the outcome and treatment tolerance of HIV-positive patients with anal cancer

Purpose: To assess the outcome and tolerance of HIV-positive patients with anal cancer to standard therapy based on their pretreatment CD4 count. Methods and Materials: Between 1991 and 1997, 17 HIV-positive patients with anal cancer and documented pretreatment CD4 counts were treated at the Uni versity of California, San Francisco or its affiliated hospitals with eithe r concurrent chemotherapy and radiation or radiation alone. The outcome and complications of treatment were correlated with the patients' pretreatment CD4 count. Results: Disease for all 9 patients with pretreatment CD4 counts greater th an or equal to 200 was controlled with chemoradiation, Although four requir ed a treatment break of 2 weeks because of toxicity, none required hospital ization. Of the 8 patients with pretreatment CD4 counts < 200, 4 experience d decreased counts, intractable diarrhea, or moist desquamation requiring h ospitalization. Additionally, 4 of these 8 ultimately required a colostomy either for a therapy-related complication or for salvage. Nevertheless, 6/7 in this group who received concurrent chemotherapy and radiation had their disease controlled, whereas the patient treated with radiation alone faile d and required a colostomy for salvage, Conclusion: Patients with CD4 greater than or equal to 200 had excellent di sease control with acceptable morbidity, Patients with CD4 < 200 had marked ly increased morbidity; however, disease was ultimately controlled in 7/8 p atients. (C) 1999 Elsevier Science Inc.