No patients had metastatic disease. 2 patients relapsed both within 6 months of diagnosis. Grade 3 haematological toxicity was recorded in 3 patients, grade 4 and 5 gastrointestinal toxicity in 1 patient each and grade 3 skin toxicity in 1 patient. Radical chemoradiation may be given safely at conventional doses in HIV-positive patients, with a high complete response rate. Malignant degeneration of anal fistula is a rare occurrence in the course of a common disease.
Abdominoperineal resection offers the only hope of cure.
Five months later, local recurrence was treated by chemotherapy and abdominoperineal resection. Two months later the patient died from cachexia with local recurrence. Biopsies of anal fistula tract and histology of all fistulectomies are required for early diagnosis of possible carcinoma.