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Clinical Observation
January 25, 2010

Primary Esophageal Carcinoma in the Era of Highly Active Antiretroviral Therapy

Author Affiliations

Author Affiliations: Department of Medical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, England (Dr Stebbing); Melanoma and Sarcoma Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Krown); Departments of Oncology and HIV Medicine, Imperial College School of Medicine, Chelsea and Westminster Hospital Foundation Trust, London (Dr Bower); Sound Shore Medical Center of Westchester, New Rochelle, New York (Dr Batra); Department of Medical Oncology, Barts and the London NHS Trust, London (Dr Slater); Epidemiology & Biostatistic Unit, Istituto di Recovero e Cura a Carattere Scientifico (IRCCS) Centro di Riferimento Oncologico, Aviano, Italy (Dr Serraino); Department of Hematology/Oncology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Dezube); Department of Medicine, Tata Memorial Hospital, Parel, Mumbai, India (Dr Dhir); and Department of Pathology, Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts (Dr Pantanowitz).

Arch Intern Med. 2010;170(2):203-207. doi:10.1001/archinternmed.2009.490

Background  As human immunodeficiency virus (HIV)-infected individuals are living longer, non–AIDS-defining cancers are becoming increasingly recognized. Primary esophageal tumors in people living with HIV have seldom been reported. We sought to document patient, virologic, and tumor characteristics and clinical outcomes in this patient group.

Methods  International physicians involved in the care of AIDS-defining and non–AIDS-defining cancers accrued cases of primary esophageal malignant neoplasms in HIV-infected individuals. Patient demographics, HIV status, cancer risk factors, esophageal tumor characteristics, treatment, and outcomes were analyzed.

Results  A total of 19 patients with primary adenocarcinoma and/or squamous cell carcinoma of the esophagus were identified. The median age was 48 years (range, 35-69 years) and the median CD4 lymphocyte count measured 376 cells/μL (range, 42 to >1000 cells/μL) (to convert to ×109/L, multiply by 0.001). The majority of patients were men with a history of smoking or considerable alcohol consumption. Prior esophageal disease (reflux, peptic ulcers, and achalasia) was reported in almost half of all patients. Seven patients (37%) underwent surgical resection, 11 (58%) received fluorouracil-based chemotherapy, and 7 (37%) underwent radiotherapy; survival correlated with stage at cancer presentation. While the majority of patients died, only 5 deaths (26%) were attributed to progression of esophageal carcinoma.

Conclusions  Primary esophageal carcinoma is another non–AIDS-defining cancer associated with moderate immunosuppression and lifestyle habits including tobacco and alcohol use. The biological behavior, treatment, and outcome of HIV-related esophageal cancer appear similar to the general population with this disease; the same screening and risk moderation strategies are likely to apply.