Disease Outcomes In Human Immunodeficiency Virus Positive Patients Treated With Primary Or Adjuvant Radiation Therapy For Head And Neck Cancer

Human immunodeficiency virus (HIV) seropositivity may be associated with higher risk of local recurrence and poor survival in multiple malignancies. However, long-term disease control in HIV+ patients with head and neck cancer is not well described. The purpose of this study is to review the disease-related outcomes of HIV+ patients who underwent radiation therapy (RT) at our institution. We retrospectively reviewed 24 consecutive HIV+ patients who underwent definitive or adjuvant RT for squamous cell carcinoma (SCC) of the head and neck at a single institution between 2004 and 2013. Data on patient characteristics, RT dose and technique and treatment outcomes were collected from patient charts. Stage was recorded according to AJCC 7th edition. Overall survival (OS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and disease-free survival (DFS) was investigated. Kaplan-Meier estimated survival was calculated. Median follow up was 21 months. Eighty-three percent were male; median age was 53 years old. Twenty-three patients (96%) had SCC and one patient had sarcomatoid SCC. Primary sites of disease included oropharynx (n = 12), larynx (n = 6), oral cavity (n = 2), unknown primary (n = 2), nasal cavity (n = 1),and paranasal sinuses (n = 1). Stage was II (16.7%), III (16.7%), IVA (58.3%) and IVB (8.3%). Median CD4 count prior to RT was 261 cells/uL (range 71-858 cells/uL). Pathologic confirmation of human papilloma virus (HPV) was available for 3 patients, 2 were HPV positive. Radiation therapy technique was 3D-conformal (62.5%) or intensity modulated radiation therapy (37.5%); 11 patients (45.8%) had concurrent chemoradiation therapy. Thirteen patients (54%) underwent definitive RT and 11 (46%) were treated adjuvantly. At most recent follow-up, 16 patients (66.7%) were alive, 20 patients (83.3%) were free of local recurrence and 19 (79%) were free of distant metastases. Kaplan-Meier estimated 3- year OS was 61% (median OS 83 mos, 95% CI 10-155 mos), LRFS was 82%, DMFS was 77% and DFS was 73%. In our cohort, HIV+ patients had excellent disease-related outcomes and overall survival following primary or adjuvant RT or CRT for head and neck SCC. These results suggest HIV+ patients carry a positive prognostic factor, such as high rates of HPV positivity. This group of patients should be managed aggressively with intent to cure.