Preliminary results of radiation therapy for prostate cancer in human immunodeficiency virus-positive patients.

OBJECTIVES: The purpose of this study was to report on the clinical outcomes of patients treated at our institution for prostate cancer (PCa) who had been previously diagnosed as Human immunodeficiency virus (HIV) positive. METHODS: The authors conducted a retrospective study of 14 PCa/HIV patients who were being treated for PCa with external beam radiotherapy, brachytherapy, or a combination of the two. Each patient's prostate-specific antigen (PSA) level, CD4 count, and viral load were obtained before the initial radiation treatment and at the time of their most recent follow-up. In addition, 13 of 14 patients completed a quality of life survey with a social worker on staff and were examined by their radiation oncologist to assess the complications after treatment. RESULTS: Comparing pretreatment data with the data at last follow-up, only 1 patient's PSA level remained above 1.1 ng/mL. The average CD4 count remained stable, increasing from 523 to 577 cells/mm(3), with the lowest final count at 200 cells/mm(3). Viral load increased in only 2 of 14 patients. There were no unusual rectal, urinary, or sexual complications, and no infections related to treatment. CONCLUSIONS: Based on changes in viral load and CD4 count, radiotherapy does not appear to have a long-term negative effect on the immune system. Treatment complications are consistent with HIV-negative patients, giving no evidence that the subset of PCa/HIV patients should be treated differently from PCa patients without HIV when considering radiation therapy. More investigation will be necessary before reliable mortality and morbidity data can be assessed.

Invasive anal squamous-cell carcinoma in the HIV-positive patient: outcome in the era of highly active antiretroviral therapy.

INTRODUCTION: The incidence of invasive anal squamous-cell carcinoma in patients with HIV is increasing. We report the outcome after combined chemoradiotherapy for anal squamous-cell carcinoma in HIV-infected individuals. METHODS: Thirty-two HIV-positive patients treated at the St. Vincent's Cancer Care Center for anal squamous-cell carcinoma from 1997 through mid 2005 were reviewed retrospectively. All patients also received highly active antiretroviral therapy. Treatment consisted of radiotherapy concurrent with 5-fluorouracil and mitomycin C in most patients. Overall survival, anal cancer-specific survival, local recurrence, and toxicity were assessed. RESULTS: Median time from completion of radiotherapy to last follow-up of surviving patients was 35 months. Five-year locoregional relapse, anal cancer-specific survival, and overall survival were 16 , 75, and 65 percent, respectively. In multivariate analysis, locoregional recurrence, cancer-specific survival, and overall survival were all significantly associated with tumor size. Overall survival was independently associated with high viral load and low CD4 count. Acute toxicity included: Grade 3 skin in 25 percent of patients, Grade 3 diarrhea: 28 percent, and Grade 3 or 4 hematologic toxicity in 21 and 48 percent, respectively. More than two-thirds of patients required radiotherapy interruption. There was no negative impact of chemoradiotherapy on viral load. CONCLUSIONS: Outcome after chemoradiotherapy for HIV-related anal squamous-cell carcinoma in the era of highly active antiretroviral therapy is comparable to outcome in patients without HIV. However, significant toxicity is seen with standard treatment regimens. Earlier diagnosis and risk-adapted therapy could lead to improved survival and decreased treatment-related morbidity.

Effects of central corneal thickness and corneal curvature on the intraocular pressure measurement by Goldmann applanation tonometer and ocular blood flow pneumatonometer.

PURPOSE: To assess the effects of central corneal thickness (CCT) and corneal curvature (CC) on the measurements of intraocular pressure (IOP) using Goldmann applanation tonometer (GAT) and the ocular blood flow pneumatonometer (OBFT). METHODS: 104 patients were recruited from a glaucoma clinic. The CCT was measured using ultrasound pachymetry and the mean radius of CC using a keratometer. The IOP of each eye was measured using both GAT and the OBFT in a random order. Right eyes only were analysed for statistical purposes. RESULTS: The mean (+/-SD) IOP by GAT and OBFT was 18.2 mmHg (+/-4.4) and 18.2 mmHg (+/-4.0), respectively, with no statistically significant difference. IOP measurement with both instruments varied with CCT and CC. GAT showed an IOP increase of 0.40 mmHg per 10 microm increase of CCT and OBFT showed an increase of 0.38 mmHg in IOP per 10 microm increase of CCT. Multiple regression analysis showed that the effect of CCT was statistically significant (P<0.001) on IOP recorded by both the GAT and OBFT but CC did not have a statistically significant effect on IOP recordings performed by either technique. CONCLUSION: IOP measurements by GAT and OBFT are positively correlated with CCT with both tonometers being similarly affected. There was no significant correlation between CC and IOP measured by either tonometer.