(ChemotherapyAdvisor) – Radiation therapy (RT) with or without chemotherapy for squamous cell carcinoma (SCC) of the head and neck appears to be less tolerated and less effective in patients who are HIV seropositive compared to observed rates in those without HIV, investigators concluded during the Multidisciplinary Head and Neck Cancer Symposium.
In the largest single-institution retrospective study reported to date, Waleed F. Mourad, MD, MSc, Beth Israel Medical Center, New York, NY, and colleagues examined the outcome of 71 patients with HIV treated for SCC of the head and neck with RT ± cisplatin, carboplatin, or cetuximab between January 1977–2010. During treatment, 50 patients (70%) were on HAART; median CD4 count was 290 (range, 203–1142).
After a median follow-up of 47 months (range, 7–140), 4-year locoregional control was 69% and overall survival 55%. Seven patients (10%) developed a second primary cancer within the first 5 years of completion of RT, 2 anal and 5 SCC of the head and neck. A significant relationship between locoregional control and duration of RT was observed (P<.001). Positive trends were observed with weight loss <10% and absence of second malignancy.
“It is of paramount importance to establish better tolerated treatment strategies to improve tolerance, toxicity, and outcomes in this growing patient population,” Dr. Mourad said in a press conference, acknowledging that advances in HAART therapy have prolonged survival for patients with HIV. One hypothesis for poorer outcomes is that patients with HIV experience more side effects from treatment, leading to more treatment breaks. In this study, treatment breaks in excess of 10, 7, and 5 days were 5.6%, 13%, and 14%, respectively.
The Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Head and Neck Society, the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Society of Nuclear Medicine.