Outcomes and Tolerance of Human Immunodeficiency Viruse-Positive US Veterans Undergoing Dose-Escalated External Beam Radiotherapy for Localized Prostate Cancer

This study analyzed the outcomes and tolerance of human immunodeficiency viruse-positive patients with prostate cancer who underwent dose-escalated external beam radiotherapy. We found that the biochemical control was comparable to that in HIV-negative patients and was well tolerated. However, there was a drop in the CD4 counts both during and after the radiation treatments, indicating that the treatment of these patients requires coordination with their infectious-disease physicians. Introduction: There are little data on the outcomes and tolerance, as well as the impact on the CD4 counts, of human immunodeficiency virus (HIV)-epositive patients with prostate cancer who undergo high-dose external beam radiotherapy. Materials and Methods: We identified 15 HIV-positive patients with prostate cancer who were treated with external beam radiation to a dose > 75.6 Gy at the New York Harbor Department of Veterans Affairs between 2003 and 2010. Kaplan-Meier analyses were used to measure biochemical control outcomes. Toxicity and CD4 counts before, after, and during treatments were analyzed. Results: A total of 15 patients were identified, with a median follow-up period of 49 months. There were 2 biochemical failures, which occurred at 28 months and 63 months, respectively. In neither of these 2 patients was there evidence of metastatic disease. The overall 5-year biochemical control was 92.3%. There appeared to be a consistent decline in the CD4 counts both during and immediately after the radiation treatments. Most of these patients had a subsequent improvement in their CD4 counts. Toxicity was mild overall, though there was 1 patient who developed rectal bleeding 11 months post treatment, which required argon plasma coagulation. Conclusion: Dose-escalated external beam radiation is well tolerated in HIV-positive patients with durable biochemical control and mild toxicity. A substantial decline in CD4 counts is associated with the radiation; therefore, these counts need to be monitored closely, in conjunction with the infectious-disease specialist. (C) 2014 Elsevier Inc. All rights reserved.