Difference in toxicity between HIV-positive and HIV-negative patients with squamous-cell cancer of the anal canal treated with concomitant radio-chemotherapy
Difference in toxicity between HIV-positive and HIV-negative patients with squamous-cell cancer of the anal canal treated with concomitant radio-chemotherapy
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DOI：
10.21037/jgo.2020.01.05
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发表时间：
2020-02-01
影响因子：
2.1
通讯作者：
Marsiglia, Hugo
中科院分区：
文献类型：
--
作者：
Casadiego-Pena, Camila;Torres-Minacapilli, Marcelo;Marsiglia, Hugo
背景：在过去的30年里，肛管鳞状细胞癌的发病率一直在增加。艾滋病毒已被发现是这种疾病发展的风险因素；放化疗(RTCT)也可能比艾滋病毒阴性患者的毒性更大。本研究旨在评价HIV阳性患者与HIV阴性患者同期接受RTCT治疗的毒性是否存在差异。方法：检索MEDLINE、EMBASE、CENTER(通过Cochrane Library-Wiley)、DARE、Lilacs书目数据库。包括至少两个对照臂的实验和分析性观察研究：对HIV阳性和HIV阴性患者进行RTCT治疗的鳞状细胞(SC)肛管癌(ACC)。结果：共发现15篇文献，14篇回顾研究和1篇系统综述。所有放射治疗(RT)技术和所有化疗药物用于治疗这种疾病包括在内。两组放疗时间(P=0.67)和剂量(P=0.53)差异无统计学意义，而CT结果则相反。HIV阳性患者的急性毒性和血液毒性显著增加，而胃肠道、皮肤病和慢性毒性在两组之间没有显著差异。鉴于这些研究的高度异质性，在包括抗逆转录病毒药物和不包括抗逆转录病毒药物的研究之间无法进行客观比较。结论：HIV阳性患者发生急性和血液毒性的风险可能比HIV阴性患者更高。鉴于数据的高度异质性，无法对抗逆转录病毒药物的使用得出准确的结论。
Background: The incidence of squamous cell carcinoma of the anal canal has been increasing over the last 30 years. HIV has been found to be a risk factor for the development of this disease; radio-chemotherapy (RTCT) may also be more toxic than in HIV-negative patients. The study aims at assessing whether there are any differences in terms of toxicity between HIV-positive and HIV-negative patients treated with concomitant RTCT.Methods: Search in MEDLINE, EMBASE, CENTRAL (via Cochrane Library-Wiley), DARE, LILACS bibliographic databases. Experimental and analytical observational studies with at least two comparative arms were included: squamous-cell (SC) anal-canal cancer (ACC) treated with RTCT in HIV-positive vs. HIV-negative patients.Results: Fifteen publications, 14 retrospective studies and 1 systematic review, were found. All radiotherapy (RT) techniques and all chemotherapeutic agents used to manage this disease were included. No differences were found in terms of duration (P=0.67) and dose (P=0.53) of RT, while CT results were contradictory. Acute and hematological toxicities were significantly higher in HIV-positive patients, while gastrointestinal, dermatological and chronic toxicities did not significantly differ between the two groups. Given the high heterogeneity of the studies, no objective comparison could be made between studies that included antiretrovirals and those that did not.Conclusions: HIV-positive patients may be at higher risk for acute and hematological toxicity than HIV-negative patients. A precise conclusion cannot be drawn on the use of antiretrovirals, given the high heterogeneity of data.