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Chen Z, Daveluy S, Baran G, Joiner M, Miller S. Re-irradiation of a Classic Kaposi's Sarcoma Using Volumetric Modulated Arc Therapy. Cureus 2024; 16:e51782. [PMID: 38322087 PMCID: PMC10845073 DOI: 10.7759/cureus.51782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
A black male in his 60s diagnosed with classic Kaposi's sarcoma presented with multiple cutaneous nodules and edema of the right foot and lower leg. He was initially treated with alitretinoin 1% topical treatment. However, 16 months after treatment with the alitretinoin, the skin lesions progressed, and he subsequently underwent a course of radiation therapy to a total dose of 2000 centigrays (cGy) in five fractions to his right foot and lower extremities. Approximately 1.5 years after the radiation therapy was completed, multiple new lesions developed on the right foot and distal lower leg. He then underwent a course of re-irradiation to this area using volumetric modulated arc therapy (VMAT) to a total dose of 3300 cGy in 11 fractions. At a four-week follow-up visit, the skin lesions had completely resolved; however, the patient experienced mild edema and tenderness of the right foot and lower leg. Although long-term outcomes need to be followed, re-irradiation showed positive short-term outcomes for classic Kaposi's sarcoma.
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Affiliation(s)
- Zhe Chen
- Radiation Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Steven Daveluy
- Dermatology, Wayne State University School of Medicine, Detroit, USA
| | - Geoff Baran
- Radiation Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Michael Joiner
- Radiation Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Steven Miller
- Radiation Oncology, Wayne State University School of Medicine, Detroit, USA
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Venkateswaran N, Ramos JC, Cohen AK, Alvarez OP, Cohen NK, Galor A, Karp CL. Spotlight on ocular Kaposi’s sarcoma: an update on the presentation, diagnosis, and management options. EXPERT REVIEW OF OPHTHALMOLOGY 2021; 16:477-489. [DOI: 10.1080/17469899.2021.1962294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Juan C. Ramos
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Adam K. Cohen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Osmel P. Alvarez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Noah K. Cohen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Surgical Services, Miami Veterans Affairs Hospital, Miami, FL, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Cohen PR, Prieto VG, Kurzrock R. Tumor Lysis Syndrome: Introduction of a Cutaneous Variant and a New Classification System. Cureus 2021; 13:e13816. [PMID: 33859885 PMCID: PMC8038896 DOI: 10.7759/cureus.13816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/05/2022] Open
Abstract
Tumor lysis syndrome, an oncological emergency, is characterized by laboratory parameters such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, as well as renal injury with an elevated creatinine. Tumor lysis syndrome is seen in patients with aggressive malignancies and high tumor burden. More frequently, it occurs in individuals with hematologic malignancies such as high-grade lymphomas (such as Burkitt lymphoma) and leukemia (such as acute lymphocytic leukemia). It also, albeit less commonly, can be seen in patients with widespread solid tumors that are rapidly proliferating and are markedly sensitivity to antineoplastic therapy. Tumor lysis syndrome is usually preceded by cancer-directed therapy; however, the syndrome can present spontaneously prior to the individual receiving malignancy-directed treatment. We reported a man with metastatic salivary duct carcinoma who had cutaneous metastases that presented as carcinoma hemorrhagiectoides. Microscopic examination demonstrated that the metastatic tumor cells had infiltrated and replaced the entire dermis. After the patient received his first dose of antineoplastic therapy, he had an excellent response and the cutaneous metastases developed into ulcers; we hypothesize that most of the dermis, which had been replaced by tumor cells, disappeared as a result of the therapeutic response, and the overlying epidermis became necrotic and shed, leaving an ulcer. His dramatic response to treatment prompted us to propose a new classification of tumor lysis syndrome, which should include the systemic form of the condition as well as the new variant: cutaneous tumor lysis syndrome. We anticipate that, with improvement in targeted therapies, there may be an increase in therapy-associated cutaneous tumor lysis syndrome.
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Affiliation(s)
- Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
| | | | - Razelle Kurzrock
- Center for Personalized Cancer Therapy, University of California San Diego Moores Cancer Center, La Jolla, USA
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Temelkova I, Tronnier M, Terziev I, Wollina U, Lozev I, Goldust M, Tchernev G. A Series of Patients with Kaposi Sarcoma (Mediterranean/Classical Type): Case Presentations and Short Update on Pathogenesis and Treatment. Open Access Maced J Med Sci 2018; 6:1688-1693. [PMID: 30337990 PMCID: PMC6182508 DOI: 10.3889/oamjms.2018.354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 08/30/2018] [Accepted: 09/01/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Kaposi’s sarcoma was first described in 1872 by Moritz Kaposi. To date, it is considered a malignant disease is originating from the endothelial cells of the lymphatic vessels believed to be infected with HHV-8. The current classification defines four major epidemiological forms of Kaposi’s sarcoma: classical, endemic, AIDS-associated, and iatrogenic. CASE REPORT: A 90-year-old male is presented with multiple plaques- and tumour-shaped brown-violet formations located on an erythematous-livid base in the area of both feet and both shanks. Two samples were taken from the lesions on the skin of the shanks, with histopathological examination and the subsequent immunohistochemistry showing Kaposi’s sarcoma. CONCLUSIONS: Kaposi sarcoma is a disease that causes difficulties both in diagnostic and therapeutic respect. The only sure way to determine the correct diagnosis is immunohistochemical staining with the anti-HHV8 antibody. Despite the wide range of systematic and local treatment options, there is still no unified algorithm and a unified strategy for the treatment of Kaposi’s sarcoma.
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Affiliation(s)
- Ivanka Temelkova
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, General Skobelev Nr 79, Sofia, Bulgaria
| | - Michael Tronnier
- Helios Klinikum GMBH-Dermatology, Venereology and Allergology Senator-Braun-Allee 33 Hildesheim, Hildesheim, Germany
| | - Ivan Terziev
- Universitetska Mnogoprofilno Bolnitsa za Aktivno Lechenie "Tsaritsa Yoanna"-Common and Clinical Pathology, Sofia, Bulgaria
| | - Uwe Wollina
- Städtisches Klinikum Dresden-Department of Dermatology and Allergology, Friedrichstrasse 41, Dresden, Germany
| | - Ilia Lozev
- Medical Institute of the Ministry of Interior-Surgery, Sofia, Bulgaria
| | - Mohamad Goldust
- Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, General Skobelev Nr 79, Sofia, Bulgaria.,Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26, Sofia, Bulgaria
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5
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Delinikolas P, Patatoukas G, Kouloulias V, Dilvoi M, Plousi A, Efstathopoulos E, Platoni K. A novel Hemi-Body Irradiation technique using electron beams (HBIe -). Phys Med 2018. [PMID: 29519403 DOI: 10.1016/j.ejmp.2017.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Certain radiation responsive skin diseases may develop symptoms on the upper or the lower half of the body. The concept of a novel Hemi-Body Electron Irradiation (HBIe-) technique, described in this work, provides a low cost, LINAC based, intermediate treatment option in between extremely localized and Total Skin irradiation techniques. MATERIALS AND METHODS The HBIe- technique, developed in our department, incorporates a custom crafted treatment chamber equipped with adjustable Pb shielding and a single electron beam in extended Source-Skin Distance (SSD) setup. The patient is positioned in 'Stanford' technique positions. The geometrical setup provides both optimal dose homogeneity and dose deposition up to a depth of 2 cm. To confirm this, the following characteristics were measured and evaluated: a) percentage depth dose (PDD) on the treatment plane produced by a single electron beam at perpendicular incidence for six fields at 'Stanford' angles, b) 2D profile of the entrance dose on the treatment plane produced by a single field and c) the total surface dose on an anthropomorphic phantom delivered by all 6 fields. RESULTS The resulting homogeneity of the surface dose in the treatment plane for an average patient was 5-6%, while surface dose homogeneity on the anthropomorphic phantom was 7% for both the upper and the lower HBIe- variants. The total PDD exhibits an almost linear decrease to a practical range of 2 g/cm2. CONCLUSION In conclusion, HBIe- was proven effective in delivering the prescribed dose to the target area, while protecting the healthy skin.
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Affiliation(s)
- Panagiotis Delinikolas
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece; Space Radiobiology Research, Physics Department, Strathclyde University, Glasgow, UK.
| | - Georgios Patatoukas
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Vasilios Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Maria Dilvoi
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Agapi Plousi
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Kalliopi Platoni
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
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Robertson-Tessi M, El-Kareh A, Goriely A. A model for effects of adaptive immunity on tumor response to chemotherapy and chemoimmunotherapy. J Theor Biol 2015; 380:569-84. [PMID: 26087282 DOI: 10.1016/j.jtbi.2015.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 05/08/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
Complete clinical regressions of solid tumors in response to chemotherapy are difficult to explain by direct cytotoxicity alone, because of low growth fractions and obstacles to drug delivery. A plausible indirect mechanism that might reconcile this is the action of the immune system. A model for interaction between tumors and the adaptive immune system is presented here, and used to examine controllability of tumors through the interplay of cytotoxic, cytostatic and immunogenic effects of chemotherapy and the adaptive immune response. The model includes cytotoxic and helper T cells, T regulatory cells (Tregs), dendritic cells, memory cells, and several key cytokines. Nearly all parameter estimates are derived from experimental and clinical data. Individual tumors are characterized by two parameters: growth rate and antigenicity, and regions of tumor control are identified in this parameter space. The model predicts that inclusion of the immune response significantly expands the region of tumor control for both cytostatic and cytotoxic chemotherapies. Moreover, outside the control zone, tumor growth is delayed significantly. An optimal fractionation schedule is predicted, for a fixed cumulative dose. The model further predicts expanded regions of tumor control when several forms of immunotherapy (adoptive T cell transfer, Treg depletion, and dendritic cell vaccination) are combined with chemotherapy. Outcomes depend greatly on tumor characteristics, the schedule of administration, and the type of immunotherapy chosen, suggesting promising opportunities for personalized medicine. Overall, the model provides insight into the role of the adaptive immune system in chemotherapy, and how scheduling and immunotherapeutic interventions might improve efficacy.
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Affiliation(s)
- Mark Robertson-Tessi
- Program in Applied Mathematics, University of Arizona, Tucson, AZ 85721, United States; Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, FL 33612, United States.
| | - Ardith El-Kareh
- ARL-Microcirculation Division, University of Arizona, Tucson, AZ 85724, United States
| | - Alain Goriely
- Mathematical Institute, University of Oxford, Woodstock Road, OX2 6GG, UK
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Park JM, Kim IH, Ye SJ, Kim K. Evaluation of treatment plans using various treatment techniques for the radiotherapy of cutaneous Kaposi's sarcoma developed on the skin of feet. J Appl Clin Med Phys 2014; 15:4970. [PMID: 25493522 PMCID: PMC5711114 DOI: 10.1120/jacmp.v15i6.4970] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 08/03/2014] [Accepted: 07/28/2014] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to investigate the plan qualities of various treatment modalities for the radiotherapy of cutaneous Kaposi's sarcoma developed on the skin of the foot. A total of six virtual targets were generated on the skin of the foot in CT images. Five types of treatment plans were generated using photon beams (PB), electron beams (EB), high‐dose‐rate (HDR) brachytherapy with a Freiburg flap applicator, intensity‐modulated radiation therapy (IMRT), and volumetric‐modulated arc therapy (VMAT) techniques. Plans for each of the six targets (single‐target plans) and also for the combined target consisting of the six single targets combined (multitarget plans) were generated. Dose‐volumetric analysis was performed for the targets and normal tissues. The averaged conformity index (CI) and homogeneity index (HI) values for each single target using PB, EB, HDR, IMRT, and VMAT techniques were 1.97, 2.39, 1.60, 4.60, and 0.80 and 1.05, 1.11, 1.52, 1.04, and 1.04, respectively. For the multitarget, the CI values were 3.99, 5.08, 1.38, 1.95, and 0.84, and the values of HI were 1.10, 1.36, 1.43, 1.06, and 1.04, respectively. The averaged mean doses to normal tissue were 2.5, 2.7, 3.6, 1.7, and 2.9 Gy for single‐target plans, and 21.3, 14.6, 14.2, 14.3, and 13.0 Gy for the multitarget plans, respectively. The VMAT demonstrated dosimetric advantages and better treatment efficiency over other techniques for the radiotherapy of multifocal skin disease of the feet. PACS number: 87.55.dk
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8
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Nicolini G, Abraham S, Fogliata A, Jordaan A, Clivio A, Vanetti E, Cozzi L. Critical appraisal of volumetric-modulated arc therapy compared with electrons for the radiotherapy of cutaneous Kaposi's sarcoma of lower extremities with bone sparing. Br J Radiol 2013; 86:20120543. [PMID: 23392192 DOI: 10.1259/bjr.20120543] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the use of volumetric-modulated arc therapy [VMAT, RapidArc® (RA); Varian Medical Systems, Palo Alto, CA] for the treatment of cutaneous Kaposi's sarcoma (KS) of lower extremities with adequate target coverage and high bone sparing, and to compare VMAT with electron beam therapy. METHODS 10 patients were planned with either RA or electron beams. The dose was prescribed to 30 Gy, 10 fractions, to mean the planning target volume (PTV), and significant maximum dose to bone was limited to 30 Gy. Plans were designed for 6-MV photon beams for RA and 6 MeV for electrons. Dose distributions were computed with AcurosXB® (Varian Medical Systems) for photons and with a Monte Carlo algorithm for electrons. RESULTS V(90%) was 97.3±1.2 for RA plans and 78.2±2.6 for electrons; similarly, V(107%) was 2.5±2.2 and 37.7±3.4, respectively. RA met coverage criteria. Concerning bone sparing, D(2%) was 29.6±1.1 for RA and 31.0±2.4 for electrons. Although acceptable for bone involvement, pronounced target coverage violations were obtained for electron plans. Monitor units were similar for electrons and RA, although for the latter they increased when superior bone sparing was imposed. Delivery times were 12.1±4.0 min for electrons and 4.8±1.3 min for the most modulated RA plans. CONCLUSION High plan quality was shown for KS in the lower extremities using VMAT, and this might simplify their management in comparison with the more conventional usage of electrons, particularly in institutes with limited staff resources and heavy workloads. ADVANCES IN KNOWLEDGE VMAT is also dosimetrically extremely advantageous in a typology of treatments where electron beam therapy is mainly considered to be effective owing to the limited penetration of the beams.
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Affiliation(s)
- G Nicolini
- Medical Physics Unit, Radiotherapy Department, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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9
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Singh NB, Lakier RH, Donde B. Hypofractionated radiation therapy in the treatment of epidemic Kaposi sarcoma--a prospective randomized trial. Radiother Oncol 2008; 88:211-6. [PMID: 18439694 DOI: 10.1016/j.radonc.2008.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 02/26/2008] [Accepted: 03/09/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare a conventional fractionation regimen with a hypofractionated regimen in the treatment of Epidemic Kaposi sarcoma with radiation therapy. MATERIALS AND METHODS Sixty patients were randomized to receive a standard regimen of 24 Gy in 12 fractions (ARM A) or the study regimen of 20 Gy in five fractions (ARM B). Radiation technique was individualized. Treatment response, local control and toxicity were recorded. RESULTS Thirty five sites were treated in ARM A and 30 sites in ARM B. Treatment arms were similar for gender, ECOG performance score, treated site, antiretroviral therapy usage, T stage, I stage and S stage. The overall survival using the Kaplan Meier method was 37% at 1 year. Complete responses were recorded at 28 sites (13 Arm A,15 Arm B), partial responses at 19 sites (8 Arm A,11 Arm B) and stable disease at three sites (2 Arm A,1 Arm B). The mean time to maximum objective response was 3 months (range: 1-14 months). Response rates and local control were equal in the two arms (p=0.73 and 0.77, respectively, log rank test). Acute skin toxicity (p=0.77) and late skin toxicity (p=0.24) were equal in the two arms. CONCLUSION The two treatment regimens produced equivalent results for treatment response, local recurrence-free survival and toxicity.
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Affiliation(s)
- Niveditha B Singh
- Division of Radiation Oncology, Johannesburg Hospital, South Africa.
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10
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Staps KL, Vissers WHPM, Kop EN, van Crevel R, Seyger M, Alkemade H. Middle-aged man presenting with erythematous brownish plaques. Diagnosis: Kaposi's sarcoma (KS) as defining disease of acquired immunodeficiency syndrome (AIDS) by HIV-1 infection. Clin Exp Dermatol 2007; 32:617-8. [PMID: 17376210 DOI: 10.1111/j.1365-2230.2007.02398.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K L Staps
- Department of Dermatology, Canisius Wilhelmina Hospital, and Radboud University Nijmegen Medical Center, The Netherlands
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Wilkins K, Turner R, Dolev JC, LeBoit PE, Berger TG, Maurer TA. Cutaneous malignancy and human immunodeficiency virus disease. J Am Acad Dermatol 2006; 54:189-206; quiz 207-10. [PMID: 16443048 DOI: 10.1016/j.jaad.2004.11.060] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 11/22/2004] [Accepted: 11/22/2004] [Indexed: 12/21/2022]
Abstract
UNLABELLED Certain skin cancers occur with increased frequency or altered course in patients infected with HIV. Malignant melanoma and squamous cell carcinoma are examples of cutaneous malignancies that have a more aggressive course in patients with HIV. Others, such as basal cell carcinoma, appear more frequently in this population but do not appear to be more aggressive. The incidence of HIV-associated Kapsosi's sarcoma has markedly decreased since the advent of HIV antiretroviral therapy. Our understanding of the pathogenesis of this malignancy and its unique management issues are fully reviewed. Cutaneous T-cell lymphoma (CTCL) is rare in this population. Other types of cutaneous lymphoma and HIV-associated pseudo-CTCL are discussed. This article addresses prevention, treatment, and follow-up strategies for this at-risk population. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with the unique epidemiology, clinical course, and management of cutaneous malignancy in patients infected with HIV.
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MESH Headings
- Algorithms
- Animals
- Anti-Retroviral Agents/administration & dosage
- Anus Neoplasms/epidemiology
- Anus Neoplasms/pathology
- Carcinoma, Basal Cell/epidemiology
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- HIV Infections/drug therapy
- HIV Infections/epidemiology
- Herpesviridae Infections/epidemiology
- Herpesvirus 8, Human/isolation & purification
- Humans
- Immunity, Cellular
- Immunohistochemistry
- Lymphoma, Large-Cell, Anaplastic/epidemiology
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Melanoma/epidemiology
- Melanoma/therapy
- Papillomaviridae
- Papillomavirus Infections/epidemiology
- Risk Factors
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/epidemiology
- Seroepidemiologic Studies
- Skin Neoplasms/epidemiology
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Affiliation(s)
- Karl Wilkins
- Department of Dermatology, University of California-San Francisco, California, USA.
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12
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Andreu Martínez FJ, Martínez Mateu JM. [The role of radiotherapy in the management of bucopharyngeal epidemic Kaposi's sarcoma]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2005; 56:368-72. [PMID: 16285436 DOI: 10.1016/s0001-6519(05)78631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study is presented to help define the role of radiotherapy in the management of buccopharyngeal epidemic Kaposi's sarcoma. MATERIAL AND METHODS Between January 1999 and December 2004, we treated 17 patients who had acquired inmunodeficiency syndrome related to mucous Kaposi's sarcoma. Kaposi's sarcoma lesions were in the oral cavity in 12 patients (70%), oropharynx in 3 patients (18%) and larynx in 2 patients (12%). All the patients were treated by radiotherapy using a Cobalt Unit beam energy, the treatment doses ranged from 15 to 30 Gy. RESULTS Tolerance was generally satisfactory, with an effective palliation of symptoms (88,4% overall rate of objective responses). Nevertheless an enhanced mucosal reaction was noted in patients receiving doses close to 30 Gy (mucositis grade 3). CONCLUSIONS We conclude that radiotherapy is an efficient treatment for mucous epidemic Kaposi's sarcoma; a dose of 15 Gy may be enough to shrink the tumour and obtain a good palliation of symptoms. Prophylactic measures with antifungal treatment should be systematically associated with oropharyngeal irradiation in order to improve tolerance to the treatment.
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Affiliation(s)
- F J Andreu Martínez
- Servicio de Oncología Radioterápica, Hospital Universitari Sant Joan, Sant Joan d'Alacant, Alicante.
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13
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Wilkins K, Dolev JC, Turner R, LeBoit PE, Berger TG, Maurer TA. Approach to the treatment of cutaneous malignancy in HIV-infected patients. Dermatol Ther 2005; 18:77-86. [PMID: 15842615 DOI: 10.1111/j.1529-8019.2005.05003.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients infected with human immunodeficiency virus (HIV) have an increased risk of developing skin cancers. These at-risk patients may have atypical presentations and/or altered clinical courses. This article will review and discuss management issues for the following malignancies: lymphomas, malignant melanoma, basal cell carcinoma, squamous cell carcinoma, and Kaposi's sarcoma.
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Lukawska J, Cottrill C, Bower M. The changing role of radiotherapy in AIDS-related malignancies. Clin Oncol (R Coll Radiol) 2003; 15:2-6. [PMID: 12602546 DOI: 10.1053/clon.2002.0100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review the current literature on the role of radiotherapy in AIDS-related malignancies published since 1997. METHODS A comprehensive literature review was undertaken to review the recent advances in the role of radiotherapy in the management of AIDS-related malignancies. This was combined with the clinical experience from our two London treatment centres for AIDS-related malignancies. A Medline/Pubmed search was performed for articles published since 1997, the year of the previous review, which also coincides with the widespread usage of highly active antiretroviral treatment (HAART). The MESH search terms used were 'HIV or AIDS' and 'radiotherapy'. This search yielded a total of 86 references. CONCLUSIONS HAART has had a major impact on the role of radiotherapy in AIDS-related malignancy. The use of HAART has led to a decline in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma and has been associated with an improved prognosis in systemic non-Hodgkin's lymphoma in people with HIV. In addition HAART alone has been successfully used as therapy for early KS lesions. Chemoradiotherapy remains the mainstay of management for anal cancer, has a central role in cervical cancer and non-AIDS defining malignancies in this population.
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Affiliation(s)
- J Lukawska
- Department of Oncology, Chelsea & Westminster Hospital, London SW10 9NH, UK
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15
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Susser WS, Whitaker-Worth DL, Grant-Kels JM. Mucocutaneous reactions to chemotherapy. J Am Acad Dermatol 1999; 40:367-98; quiz 399-400. [PMID: 10071309 DOI: 10.1016/s0190-9622(99)70488-3] [Citation(s) in RCA: 223] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED Chemotherapeutic agents are a widely used treatment modality. Side effects range from common to unusual and may be confused with other cutaneous sequelae of oncologic treatment. The goal of this communication is to elaborate on previous descriptions of the cutaneous manifestations of chemotherapeutic treatment and to discuss more recent findings. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be able to generate a differential diagnosis of possible etiologies for varying patterns of cutaneous involvement in patients receiving chemotherapy and identify the various cutaneous side effects of chemotherapeutic treatment. In addition, they should be able to distinguish life-threatening side effects that require immediate management from more benign manifestations of chemotherapeutic treatment.
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Affiliation(s)
- W S Susser
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, USA
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Abstract
Radiotherapy plays an important role in the treatment of skin tumours. For skin carcinomas, external irradiation (kilovoltage X-rays or electrons according to clinical characteristics) is more valuable than interstitial brachytherapy, which is recommended for tumours of the lip and of the nasal vestibule. In mycosis fungoides, total cutaneous electron beam radiation therapy is efficient for patients with limited superficial plaques. In the classical form of Kaposi's sarcoma, radiotherapy can achieve local control whereas it obtains good palliative results in the epidemic form.
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Affiliation(s)
- E Calitchi
- Département de cancérologie, Hôpital Henri-Mondor, Créteil, France
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Abstract
Moriz Kaposi was the first who, in 1872, described five patients presenting with "sarcoma idiopathicum multiple hemorrhagicum". In 1912 Sternberg termed this disease Kaposi's sarcoma. Since then various forms of this rare disease have been observed. In 1914 Hallenberg described the first cases of African or endemic Kaposi's sarcoma. In the 1960s the first reports discussing Kaposi's sarcoma following organ transplantation and immunosuppressive therapy were published. After 1981, the epidemic form associated with the acquired immunodeficiency syndrome (AIDS) was described. All these forms, their history, treatment methods and the role of radiation therapy in the management of this rare malignancy are discussed, and the literature is reviewed.
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Affiliation(s)
- Y M Kirova
- Département de cancérologie, Hôpital Henri-Mondor, Créteil, France
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Kirova YM, Belembaogo E, Frikha H, Haddad E, Calitchi E, Levy E, Piedbois P, Le Bourgeois JP. Radiotherapy in the management of epidemic Kaposi's sarcoma: a retrospective study of 643 cases. Radiother Oncol 1998; 46:19-22. [PMID: 9488122 DOI: 10.1016/s0167-8140(97)00147-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To report to the literature the largest published series of epidemic Kaposi's sarcoma (EKS), treated with radiation therapy, to summarize and discuss our 10 years experience in the treatment of this malignancy. METHODS AND MATERIALS From June 1986 to December 1996, 643 patients with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma were treated with radiation therapy (RT) at the Cancerology Department of Henri Mondor University Hospital. The patients, 640 men and 3 women had an average age of 38.5 years (range 20-68 years). Three hundred eighty-seven patients (60.1 %) had received previous treatment for their Kaposi's sarcoma (KS). In total, 6777 fields were irradiated, as follows: face 1342 (19.8%), eyelid and conjunctiva 362 (5.3%), trunk 1903 (28.1%), upper and lower limbs 2866 (42.3%), genitals 189 (2.8%). and oral cavity 115 fields (1.7%). Radiation therapy consisted of 4 MV or 45-70 kV X-rays, depending on tumor size and location. Doses ranged from 10 to 30 Gy, according to tumor response and toxicity. RESULTS Objective response (CR and PR) was observed in 92% (5947/6464) of all cases, treated for cutaneous form of EKS. All patients with irradiated oral lesions had an objective response. The overall tolerance was acceptable for the cutaneous lesions. By contrast, in oral lesions, mucosal reactions were often observed after relatively low doses of radiotherapy. CONCLUSIONS Doses of 15 Gy for oral lesions, 20 Gy for lesions involving eyelids, conjunctiva, and genitals, have been shown to be sufficient to produce shrinkage of the tumor and good palliation of the symptoms. For the cutaneous EKS, we propose 30 Gy given in a local field, using a fractionated scheme with small size applicators. Radiotherapy has its own place in the management of EKS, as an efficient treatment.
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MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Adult
- Aged
- Conjunctival Neoplasms/epidemiology
- Conjunctival Neoplasms/etiology
- Conjunctival Neoplasms/radiotherapy
- Dose-Response Relationship, Radiation
- Eyelid Neoplasms/epidemiology
- Eyelid Neoplasms/etiology
- Eyelid Neoplasms/radiotherapy
- Female
- Follow-Up Studies
- Genital Neoplasms, Female/epidemiology
- Genital Neoplasms, Female/etiology
- Genital Neoplasms, Female/radiotherapy
- Genital Neoplasms, Male/epidemiology
- Genital Neoplasms, Male/etiology
- Genital Neoplasms, Male/radiotherapy
- Humans
- Male
- Middle Aged
- Mouth Neoplasms/epidemiology
- Mouth Neoplasms/etiology
- Mouth Neoplasms/radiotherapy
- Recurrence
- Retrospective Studies
- Sarcoma, Kaposi/epidemiology
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/radiotherapy
- Skin Neoplasms/epidemiology
- Skin Neoplasms/etiology
- Skin Neoplasms/radiotherapy
- Treatment Outcome
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Affiliation(s)
- Y M Kirova
- University Hospital Henri Mondor, Department of Cancerology, Creteil, France
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Bélembaogo E, Kirova Y, Frikha H, Yu SJ, Piedbois P, Le Bourgeois JP. [Radiotherapy of epidemic Kaposi's sarcoma: the experience of the Henri-Mondor Hospital (643 patients)]. Cancer Radiother 1998; 2:49-52. [PMID: 9749096 DOI: 10.1016/s1278-3218(98)89061-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Retrospective analysis of results of radiotherapy in epidemic Kaposi sarcoma at the Henri-Mondor hospital. MATERIAL AND METHODS From June 1986 to December 1996, 643 patients presenting with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma were treated with irradiation at the Oncology Department of Henri Mondor University Hospital. Three-hundred eighty-seven patients (60%) had previously received a treatment with interferon (259 patients, 40.2%), vinblastine (225 patients, 34.5%), doxorubicin (22 patients, 3.4%), bleomycin (19 patients, 2.9%), and/or antiviral treatment (216, 33.5%). The radiotherapy was delivered by 4 MeV or 8 MeV electron beam for extended cutaneous fields and 45-100 kV x-ray for localized fields. The delivered dose was 20 Gy in 2 weeks (2.5 Gy/fraction, 4 fractions/week) followed by 2 weeks rest and second series of 10 Gy in 1 week. For oral cavity lesions, we used a series of 15.2 Gy was delivered (1.9 Gy/fraction, 4 fractions/week), followed for three patients by a 3 week rest and by a similar second series of 15.2 Gy. RESULTS Six-hundred and twenty-one patients were evaluable and the objective response rate was 92%, with a complete regression of clinical and functional symptoms for all patients. The skin tolerance was good, with 7.3% grade I reactions, 69.3% of grade II reactions, and 23.4% grade III reactions. There was a correlation between recurrence rate and the occurrence of opportunistic infections. CONCLUSION This analysis shows the efficacy of dose radiotherapy for treatment of epidemic Kaposi sarcoma.
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Affiliation(s)
- E Bélembaogo
- Département de cancérologie, hôpital Henri-Mondor, Créteil, France
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Abstract
The clinical appearance of Kaposi's sarcoma (KS) can cause significant disfigurement and lead to functional impairment, particularly if the lesions ulcerate and become secondarily infected. We describe a patient with a KS plaque on the face that was successfully treated with 585-nm pulsed dye laser (PDL) therapy. No recurrence of the tumor was noted 12 months after the final laser treatment.
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Affiliation(s)
- N Marchell
- Washington Institute of Dermatologic Laser Surgery, DC, USA
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Wooden KK, Hogstrom KR, Blum P, Gastorf RJ, Cox JD. Whole-limb irradiation of the lower calf using a six-field electron technique. Med Dosim 1996; 21:211-8. [PMID: 8985926 DOI: 10.1016/s0958-3947(96)00129-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present work demonstrates utilization of electron beam irradiation for the treatment of Kaposi's sarcoma when the full circumference of the lower calf is involved, and when the deep lymphatics are negative for disease. The finite penetration of the electron beam spares deep tissue, preventing the edema associated with photon total limb irradiation. The number of fields with fall-off required to produce a uniform dose to a cylindrical anatomic structure was studied by calculating dose distributions resulting from two-, four-, and six-field techniques for a 5-MeV electron beam and a 9 cm diameter cylinder. The dosimetry and set-up for the six-field technique is demonstrated by a case study. Results show that a six-field electron technique produced a sufficiently uniform dose while remaining relatively easy to set up and use to deliver patient treatment. For the patient case study, dose distributions for the six-field technique showed that (1) the penetration of the 90% dose decreased from 1.5 cm for a single field to approximately 1.0 cm for a 5-MeV beam; (2) the surface dose increased from approximately 70% to 100%, (3) the dose around the circumference of the leg at the depth of 1 cm or less varied from approximately 90% to 120% of the prescribed dose; and (4) the prescribed dose was 2.5 times the maximum central-axis dose from a single field. The six-field treatment was relatively simple to apply and produced an acceptable dose distribution for treatment of Kaposi's sarcoma of the lower calf. This treatment should be applicable to other sites such as the thigh and arms and for other cutaneous diseases such as melanoma.
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Affiliation(s)
- K K Wooden
- University of Texas M.D., Anderson Cancer Center, Houston 77030, USA
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Swift PS. The role of radiation therapy in the management of HIV-related Kaposi's sarcoma. Hematol Oncol Clin North Am 1996; 10:1069-80. [PMID: 8880197 DOI: 10.1016/s0889-8588(05)70385-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Radiation provides excellent palliation for symptomatic Kaposi's sarcoma in the settings of both limited and advanced disease. Integration of radiotherapy into the overall treatment strategy is critical to ensure that the benefits in terms of symptom reduction are not outweighed by a long-term increase in morbidity.
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Affiliation(s)
- P S Swift
- Department of Radiation Oncology, University of California, San Francisco, USA
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23
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Millar JL, Goldstein D, Gelmon KA. 5.14 HIV and Kaposi's sarcoma. Med J Aust 1996. [DOI: 10.5694/j.1326-5377.1996.tb122167.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Piccinno R, Caccialanza M, Cusini M. Role of radiotherapy in the treatment of epidemic Kaposi's sarcoma: experience with sixty-five cases. J Am Acad Dermatol 1995; 32:1000-3. [PMID: 7538517 DOI: 10.1016/0190-9622(95)91339-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Treatment of Kaposi's sarcoma (KS) associated with HIV infection should improve often disfiguring lesions, with an acceptable cosmetic outcome; relieve associated signs and symptoms (pain and edema); and have no adverse effects on the patient's already impaired immune status. OBJECTIVE Our purpose was to determine the role of x-ray therapy in the treatment of KS. METHODS Contact x-ray therapy and half-deep x-ray therapy were used to treat 594 lesions in 65 patients with KS, who were observed for 1 to 43 months (mean, 9 months). RESULTS Complete remission was achieved with pigmentation in 405 lesions (68.3%), with good cosmetic results in 105 (17.7%), and with hypopigmentation in three (0.5%). In 80 lesions (13.5%) only size reduction or pain palliation were achieved. Fourteen lesions (2.4%) relapsed 2 to 9 months after treatment. CONCLUSION X-ray therapy is well tolerated and meets the specified requirements for the treatment of KS.
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Affiliation(s)
- R Piccinno
- Department of Photoradiotherapy, University of Milan-Ospedale Maggiore, IRCCS, Italy
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Webster GF. Local therapy for mucocutaneous Kaposi's sarcoma in patients with acquired immunodeficiency syndrome. Dermatol Surg 1995; 21:205-8. [PMID: 7712086 DOI: 10.1111/j.1524-4725.1995.tb00153.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Kaposi's sarcoma (KS) accounts for significant morbidity in AIDS patients. Lessons are often numerous, disfiguring, painful, and may interfere with function. Although generalized therapy is available, local treatment is often more desirable. OBJECTIVE To summarize the available data on local therapy for KS. METHODS Literature was searched using Medline. RESULTS Excision, laser destruction, cryotherapy, intralesional chemotherapy, immunotherapy, and radiation therapy were compared for success rate, cost, and convenience. CONCLUSION Intralesional therapy, cryotherapy, and radiation all have substantial advantages over excision or laser surgery. Choice of the appropriate modality varies with different sites and patients.
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Affiliation(s)
- G F Webster
- Department of Dermatology, Jefferson Medical College, Philadelphia, Pennsylvania 19107-5102, USA
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Piedbois P, Frikha H, Martin L, Levy E, Haddad E, Le Bourgeois JP. Radiotherapy in the management of epidemic Kaposi's sarcoma. Int J Radiat Oncol Biol Phys 1994; 30:1207-11. [PMID: 7525519 DOI: 10.1016/0360-3016(94)90330-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE This study is presented to help define the role of radiotherapy in the management of epidemic Kaposi's sarcoma. METHODS AND MATERIALS Between June 1986 and June 1993, we treated 453 patients who had acquired immunodeficiency syndrome related Kaposi's sarcoma. Two hundred fifty-two patients (55.6%) had received previous treatment for their Kaposi's sarcoma: 228 (55.3%) with interferon, and 116 (25.6%) with Vinblastine. Depending on both tumour size and location, patients were treated with extended cutaneous irradiation using 4 MeV electron beam energy and/or localized irradiation using 45-100 kV x-ray (cutaneous lesions), or 4 MV x-ray (oral tumours). A total of 5015 courses of radiation therapy was given. The intention of the treatment was closely linked to the anatomic sites. Multiple courses of treatment ranging from 10 to 20 Gy (2.5 Gy/fraction, 4 times/week) were used for Kaposi's sarcoma involving conjunctiva (n = 32 treatments), eyelids (n = 306), lips (n = 170), hands (n = 208), feet (n = 417), penis (n = 131), oral mucosa (n = 43), and anal region (n = 5). A second group including other cutaneous sites (face, trunk, limbs) was treated with a dose of 30 Gy (20 Gy in 2 weeks followed by 2 weeks rest and then a second series of 10 Gy in 1 week). RESULTS For the first group, tolerance was generally good excluding oral cavity irradiation, with an effective palliation of symptoms (87.8% overall rate of objective responses); an enhanced mucosal reactions was noted in patients receiving oropharyngeal irradiation. For the second group, a complete regression rate of 85% was observed; tolerance was acceptable: complications were severe epidermitis with skin ulceration (5%), exsudative epidermitis (26%), dry epidermitis (60%), and varying degrees of erythema (9%). There was a significant correlation between risk of recurrence (overall recurrence rate of 71% after an average of 7.5 months) and occurrence of opportunistic infections: 85% of recurrences appeared concomitantly with accelerated course of acquired immunodeficiency syndrome. CONCLUSIONS We conclude that radiotherapy is an efficient treatment for epidemic Kaposi's sarcoma (EKS): doses of 15.2 Gy for oral lesions and 20 Gy for lesions involving conjunctiva, eyelids, lips, hands, feet, penis, and anal region were sufficient to produce shrinkage of the tumour and good palliation of symptoms. For the other cutaneous sites, 30 Gy local field irradiation could be safely given with better short-term response. Prophylactic measures with antifungal treatment should be systematically associated with oropharyngeal irradiation, to improve tolerance to the treatment.
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Affiliation(s)
- P Piedbois
- Département de Cancérologie, Hôpital Henri Mondor, Creteil, France
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Stein M, Spencer D, Kantor A, Lakier R, Lachter J, Ben-Yosef R, Bezwoda WR. Radiation Therapy in Epidemic, Aids-Related Kaposi's Sarcoma in Southern Africa. TUMORI JOURNAL 1994; 80:216-9. [PMID: 7519802 DOI: 10.1177/030089169408000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aims and background Acquired Immunodeficiency Syndrome (AIDS) associated Kaposi's Sarcoma (EKS) is widely spread in the Southern African Region. No large studies concerning the role of radiation therapy in the Southern African variant of EKS have been reported to date. Methods Over a 10 year period (1982-1992) 25 patients with EKS (disseminated skin involvement) were treated primarily with radiation therapy at the Johannesburg General Hospital. Radiation fields were individually tailored to the extent of the disease. Total administered doses ranged between 8-12 Gy (single fraction) to 24-30 Gy fractionated over 2-3 weeks. Results Overall response and symptomatic relief rates were 72% and 80%, respectively. Toxicity was mild and manageable. Conclusions Our retrospective analysis supports the use of radiation therapy for the Southern African type of EKS.
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Affiliation(s)
- M Stein
- Department of Medical Oncology & Hematology, University of the Witwatersrand, RSA
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Corbeil J, Rapaport E, Richman DD, Looney DJ. Antiproliferative effect of retinoid compounds on Kaposi's sarcoma cells. J Clin Invest 1994; 93:1981-6. [PMID: 8182129 PMCID: PMC294306 DOI: 10.1172/jci117190] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A panel of retinoid compounds (tretinoin, isotretinoin, acitretin, and RO13-1470) were tested for inhibitory activity against Kaposi's sarcoma cell (KSC) cultures in vitro. Tretinoin was found to be the most effective retinoid tested, inhibiting the growth of KSC in vitro while having no effect on the expression of interleukin-6 and basic fibroblast growth factor, two important cytokines involved in KSC growth. Tretinoin also did not appear to downregulate the expression of receptors for these two cytokines. At low concentrations (10(-9) M), acitretin and tretinoin selectively inhibited growth of early passage KSC. At higher concentrations (10(-6)-10(-5) M), retinoid treatment induced a pattern of DNA degradation and morphological changes in KSC characteristic of apoptosis (programmed cell death). The inhibitory activity of tretinoin on KSC growth was decreased if human serum (but not fetal calf serum) was present in the growth medium, and partially restored by removal of serum lipids. These data suggest that retinoids possess potential as therapeutic agents in Kaposi's sarcoma.
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Affiliation(s)
- J Corbeil
- Department of Pathology, University of California San Diego, La Jolla 92093
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31
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Le Bourgeois JP, Frikha H, Piedbois P, Le Péchoux C, Martin L, Haddad E. Radiotherapy in the management of epidemic Kaposi's sarcoma of the oral cavity, the eyelid and the genitals. Radiother Oncol 1994; 30:263-6. [PMID: 7516086 DOI: 10.1016/0167-8140(94)90467-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
From January 1987 to December 1992, 420 patients with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma (EKS) were treated with radiotherapy at the oncology department in the Henri Mondor Hospital. Of these, 146 (34.7%) exhibited tumours at 186 sites; 35 were oral, 102 eyelid or conjunctival (ophthalmic), and 49 penile or scrotal (genital) sites. Most patients had received prior chemotherapy. Radiation therapy consisted of 4 MV or 45 kV X-rays, depending on tumor size and location. Doses ranged from 10 to 30 Gy, according to tumor response and toxicity. In oral lesions mucosal reactions were often observed after relatively low doses of radiotherapy. In 27 patients receiving 15 Gy, severe reactions were observed in 6 (22%), moderate reactions in 4 (15%) and mild reactions in 17 (63%). By contrast, irradiation of eyelid or conjunctival lesions and genital lesions, was well-tolerated. Treatment was generally successful in achieving good symptom palliation. Eyelid and conjunctival Kaposi's sarcoma seemed to be more radiosensitive when compared with cutaneous sites: a high objective remission rate (96%, 98/102) was observed at doses ranging from 10 to 20 Gy. Penile and scrotal lesions showed a good response to low dose radiation (complete response was scored in 34/49 patients (69.4%)). A meticulous evaluation of tolerance was necessary. Toxicity of oropharyngeal irradiation at relatively low doses is an argument for a restrictive use of this procedure in oral lesions.
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Affiliation(s)
- J P Le Bourgeois
- Département de cancérologie, Hôpital Henri Mondor, Creteil, France
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Stein ME, Lakier R, Spencer D, Dale J, Kuten A, MacPhail P, Bezwoda WR. Radiation therapy for non-AIDS associated (classic and endemic African) and epidemic Kaposi's sarcoma. Int J Radiat Oncol Biol Phys 1994; 28:613-9. [PMID: 8113104 DOI: 10.1016/0360-3016(94)90186-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE A retrospective analysis of patients with non-AIDS and AIDS-related Kaposi's sarcoma, who were treated with radiation therapy. METHODS AND MATERIALS Between 1978 and 1992, 56 patients with one of the three major types (classical, endemic, epidemic) of Kaposi's sarcoma received radiation therapy as their sole treatment modality. Extent of fields, daily fractionation, and total dose were applied on a clinical basis. These lesions received superficial x-ray therapy, Co-60 teletherapy, or 6-8 MeV electron beams. Field sizes depended on extent of the lesion. Total dose administration ranged from 8-12 Gy in one exposure, or a total of 24-30 Gy fractionated over 2-3 weeks. RESULTS The majority of patients responded to radiation therapy. Symptomatic relief was achieved in 80-100% of patients irrespective of the type of Kaposi's sarcoma, treatment modality, or schedule. Side effects were tolerable in all but three patients with epidemic type Kaposi's sarcoma, who developed severe mucositis. CONCLUSION Radiotherapy is the most useful mode of palliative treatment for all forms of Kaposi's sarcoma in southern African patients.
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Affiliation(s)
- M E Stein
- Department of Medical Oncology and Hematology, University of the Witwatersrand, Johannesburg, Republic of South Africa
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Stelzer KJ, Griffin TW, Koh WJ. Radiation recall skin toxicity with bleomycin in a patient with Kaposi sarcoma related to acquired immune deficiency syndrome. Cancer 1993; 71:1322-5. [PMID: 7679610 DOI: 10.1002/1097-0142(19930215)71:4<1322::aid-cncr2820710425>3.0.co;2-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Radiation recall is a recurrence of acute toxicity within a previously quiescent radiation field that occurs with subsequent administration of chemotherapy. METHODS A patient with acquired immune deficiency syndrome (AIDS)-related Kaposi sarcoma (KS) who had radiation recall is reported. The patient was participating in a randomized prospective trial of radiation treatment regimens for KS. Each lesion was randomized to one of three possible radiation fractionation schemes. All lesions were photographed and measured before treatment with radiation. RESULTS Two skin sites developed erythema and dry desquamation 18 days after completion of radiation therapy to a dose of 40 Gy in 20 fractions. These reactions took place after the second dose of bleomycin administered intravenously on a weekly basis. The reactions were exacerbated by oral etoposide therapy, which was started 4 days after the recall phenomenon was noted. Other cutaneous sites treated with 8 Gy in a single fraction and 20 Gy in ten fractions during the same time period showed no sign of recall skin toxicity. CONCLUSIONS The authors believe this to be the first report of radiation recall toxicity after bleomycin therapy and of a radiation dose response related to this phenomenon. The potential for radiation recall toxicity should be considered in treatment decisions pertaining to patients with AIDS-associated KS.
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Affiliation(s)
- K J Stelzer
- Department of Radiation Oncology, University of Washington Medical Center, Seattle 98195
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