Radiation therapy in endemic (African) Kaposi's sarcoma

Radiotherapy in the Management of Kaposi’s Sarcoma

INTRODUCTION

Of all types of Kaposi's sarcoma (KS), only AIDS (acquired immunodeficiency syndrome)-related KS is of clinical importance, although its incidence has significantly declined in the last years. KS is considered a radiosensitive tumor, and good palliation of symptoms can be achieved with radiotherapy.

MATERIAL AND METHODS

Evident radiotherapy data in the available literature were reviewed to analyze and evaluate indications, techniques, dose concepts and outcomes in radiation treatment of KS.

RESULTS

Good palliation of KS symptoms can be achieved by radiotherapy, with more than 90% response and 70% complete remission. For patients with far advanced AIDS, a single dose of 8 Gy is preferable. The following doses have been shown to be sufficient: 15 Gy for oral lesions, 20 Gy for lesions involving the eyelids, conjunctivae and genitals, 30-40 Gy in single doses of 2 Gy for cutaneous lesions. Side effects are rare, and radiation is usually well tolerated, with minimal skin reactions -- except for patients with mucosa lesions, where a high degree of mucositis is often observed.

CONCLUSION

Radiotherapy has its place in the management of KS as an efficient treatment, often representing the optimal local therapy for palliation of pain, bleeding or edema.

Response and cosmetic outcome of two fractionation regimens for AIDS-related Kaposi's sarcoma

PURPOSE

A prospective study of the response and cosmetic effect of two short duration radiotherapy regimens in the treatment of epidemic cutaneous Kaposi's sarcoma.

MATERIALS AND METHODS

Between June 1990 and May 1994, 57 patients were recruited into a prospective study of radiotherapy for cutaneous epidemic Kaposi's sarcoma. Patients were offered treatment of either 16 Gy in four fractions over 4 days or 8 Gy as a single fraction. In total 596 lesions were treated in a prospective fashion. Response was assessed in 590 and pigmentation in 573 lesions. A reproducible scale for assessing response and normal cutaneous damage was developed and used to grade the results of treatment.

RESULTS

There was an overall response rate of 78.8% (465/590) for complete responses and pigmented complete responses. Patients receiving 8 Gy as a single fraction had an overall response rate of 77.6% (305/393) and those treated with 16 Gy in four fractions had a response rate of 80.8% (160/198). There was no statistical difference in terms of response between the two groups. There appeared to be a significant variation in response and normal skin pigmentation according to the site irradiated with facial lesions responding best.

CONCLUSIONS

Radiotherapy is a quick and effective treatment for cutaneous epidemic Kaposi's sarcoma. A single fraction of 8 Gy is an appropriate treatment for acceptable response and normal skin pigmentation within a group of patients in whom the median life expectancy is limited.

Kaposi's sarcoma: advances and perspectives

Kaposi's sarcoma (KS) is an unusual neoplasm that has proved to be an enigma in many ways since its original description by Kaposi in 1872. Its epidemiology has stimulated tremendous interest, amplified markedly in 1981 when it became known as an original defining part of the complex of immune disorders now known as AIDS. The cell of origin, etiology, and therapy for both AIDS-associated and AIDS-unassociated KS continue as matters of intense investigation. In fact, whether it is a reactive hyperplasia or a true malignancy is still a matter of debate, as is the concept of multicentricity versus metastases. Epidemiologic studies suggest that a separate agent apart from HIV-1 may cause KS. A newly postulated KS-associated herpes virus may be linked. The role of the HIV-1 tat gene product, basic fibroblast growth factor, scatter factor, oncostatin M, and other factors that regulate the growth of KS cells are discussed, as well as therapeutic options.