Squamous cell carcinoma of the anus （SCCA） is a com- mon cancer in the human immunodeficiency virus （HIV）- infected population, and its incidence continues to in- crease in male homosexuals. Combined chemoradiatio...Squamous cell carcinoma of the anus （SCCA） is a com- mon cancer in the human immunodeficiency virus （HIV）- infected population, and its incidence continues to in- crease in male homosexuals. Combined chemoradiation with mitomycin C and 5-fiuorouracil was poorly tolerated by severely immunocompromised patients in the early 1990s. In the era of highly active antiretroviral therapy （HAART）, however, recent data indicate that： （1） most HIV patients with anal cancer can tolerate standard chemotherapy regimens; and （2） this approach is associ- ated with survival rates similar to those of HIV-negative patients. However, HIV-positive patients with SCCA are much younger, more likely to develop local tumor recur- rence, and ultimately die from anal cancer than immune competent patients. Taken together, these findings suggest that anal cancer is an often fatal neoplasia in mid- dle-aged HIV-positive male homosexuals. In this popula- tion, SCCA is an opportunistic disease resulting in patients with suboptimal immune function from persistent infection and prolonged exposition to oncogenic human papillomaviruses （HPVs）. Large-scale cancer-prevention strategies （routine anuscopy and anal papanicolaou test- ing） should be implemented in this population. In addi- tion, definitive eradication of oncogenic HPVs within the anogenital mucosa of high-risk individuals might require a proactive approach with repeated vaccination.展开更多
文摘Squamous cell carcinoma of the anus （SCCA） is a com- mon cancer in the human immunodeficiency virus （HIV）- infected population, and its incidence continues to in- crease in male homosexuals. Combined chemoradiation with mitomycin C and 5-fiuorouracil was poorly tolerated by severely immunocompromised patients in the early 1990s. In the era of highly active antiretroviral therapy （HAART）, however, recent data indicate that： （1） most HIV patients with anal cancer can tolerate standard chemotherapy regimens; and （2） this approach is associ- ated with survival rates similar to those of HIV-negative patients. However, HIV-positive patients with SCCA are much younger, more likely to develop local tumor recur- rence, and ultimately die from anal cancer than immune competent patients. Taken together, these findings suggest that anal cancer is an often fatal neoplasia in mid- dle-aged HIV-positive male homosexuals. In this popula- tion, SCCA is an opportunistic disease resulting in patients with suboptimal immune function from persistent infection and prolonged exposition to oncogenic human papillomaviruses （HPVs）. Large-scale cancer-prevention strategies （routine anuscopy and anal papanicolaou test- ing） should be implemented in this population. In addi- tion, definitive eradication of oncogenic HPVs within the anogenital mucosa of high-risk individuals might require a proactive approach with repeated vaccination.
