Kaposi's sarcoma: a review of 136 Rhodesian African cases

Anogenital Lesions: Kaposi's Sarcoma and Its Mimicks

Kaposi's sarcoma (KS) is a low-grade vascular neoplasm associated with human herpes virus-8 (HHV-8) infection, and, in the epidemic form, with the human immunodeficiency virus (HIV). Although HHV-8 is present in all body fluids and is sexually transmitted, there are surprisingly few reports of anogenital KS. Clinically, especially in HIV/KS endemic areas, dark stained skin patches or nodules are prone to misdiagnosis, especially in dark-skinned individuals. Therefore, a biopsy is recommended. The histologic appearance spans a broad spectrum of KS and non-KS lesions; therefore, the final diagnosis should be confirmed by HHV-8 immunohistochemistry. We report a series of 36 anogenital biopsies from a group of 16 documented HIV-positive patients; in 20 the HIV serostatus was unknown. There were ten KS (five in HIV-positive patients), and 26 non-KS (11 in HIV-positive subjects) lesions. In the era of HIV/AIDS, anogenital lesions may be the first manifestation of KS in immunocompromised individuals and should be biopsied. The histological diagnosis should be confirmed by HHV-8 immunohistochemistry.

Variants of Kaposi's sarcoma in Southern Africa. A retrospective analysis (1980-1992)

All types of Kaposi's sarcoma (KS) are represented in the Southern African region. We present a retrospective analysis of patients with KS, treated and followed up at the Johannesburg General Hospital over a 12-year period (1980-1992). One hundred and nineteen patients with KS, divided into four groups according to their etiology (classical; endemic African; renal transplant recipients; epidemic AIDS-related) were analyzed. Choice of treatment (radiotherapy or chemotherapy) was individualized and based on clinical criteria, extent of disease and severity of symptoms. Kaposi's sarcoma showed a very high response rate to radiation therapy, regardless of variant, radiation modality or schedule. Chemotherapy was also effective in the more aggressive pattern of endemic African KS. Epidemic Kaposi's sarcoma showed the same poor outcome as demonstrated by its Western counterpart. We conclude that radiation therapy can provide excellent palliation with only minimal side-effects in all variants of KS seen in Southern Africa.

Radiation Therapy in Epidemic, Aids-Related Kaposi's Sarcoma in Southern Africa

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.

Radiation Therapy in an Elderly African Population with Kaposi's Sarcoma

There are no published studies on the efficacy of modern radiation therapy in elderly populations with the endemic African type of Kaposi's sarcoma (AKS). The present retrospective analysis of 20 elderly AKS patients treated by radiotherapy attempts to supply information relevant to the older age group. It demonstrates that excellent symptomatic relief with minimal side effects can be attained and suggests that the role of radiotherapy as the treatment of choice in this particular group should be emphasized.

Radiation therapy for non-AIDS associated (classic and endemic African) and epidemic Kaposi's sarcoma

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.

Megavoltage radiotherapy using water bolus in the treatment of Kaposi's sarcoma

Between 1976 and 1983, 28 patients with Kaposi's sarcoma were treated in the Department of Radiation and Clinical Oncology of the Hadassah University Hospital in Jerusalem. Most of the patients (16, i.e. 57%) were Jews of European origin. Eighteen (64.2%) of the patients presented with severe leg edema in addition to multifocal, disseminated skin lesions. Only one patient was free of clinical disease in the lower extremities. Large, ulcerated masses were seen in three patients. The affected limbs were immersed in a water bath and irradiated with two-opposing portals to a total dose of 3000 rads. Total disappearance of the skin lesions was achieved in 89% of the patients, although the limb edema regressed completely in only 56% of the patients.

The treatment of Kaposi's sarcoma by combination chemotherapy in Nigeria

Kaposi's sarcoma is known to be multicentric in origin. It starts predominantly on the skin but visceral organs can be involved as well. Previous experience in the management of this condition in Lagos, Nigeria has been based mainly on the use of local radiotherapy. A better understanding of the natural history and clinicopathological features of this disease has given prominence to the use of chemotherapy and this is now being advocated as the first line of management in most cases in place of radiotherapy. Experience and results of the use of multiple chemotherapy in 10 cases seen at the Lagos University Teaching Hospital between 1976 and 1982 are discussed. Seven patients (70%) showed complete tumour regression, two (20%) had partial response and one (10%) did not respond.

Oropharyngeal Kaposi's sarcoma. Report of two cases and review of the literature

Two cases of Kaposi's sarcoma involving the oropharynx are described. The pathology of the condition is reviewed and the problems of treatment outlined.

Vitiligo associated with Kaposi's sarcoma

A patient who had Kaposi's sarcoma and an associated vitiligo is reported. This is the first known case of Kaposi's sarcoma associated with vitiligo.

Once weekly total and subtotal skin electron beam therapy for Kaposi's sarcoma

Although Kaposi's sarcoma (KS) usually appears with solitary skin lesions, in a large percentage of these patients the disease progresses eventually to involve large extensive segments of the skin. In the past, the most frequently used approach is the irradiation of isolated lesions as they arose, hence the so-called "chasing technique." Since 1971, a technique of once weekly total skin electron beam therapy (TSEB) has been employed at Memorial Hospital for mycosis fungoides and other cutaneous malignancies involving large areas of the body. Four hundred rads once weekly for six to eight consecutive weeks are delivered to the entire skin surface by employing a 3.5 MeV electron beam. Twenty patients with KS treated by this technique have been followed for 12--98 months, median 48 months. Overall response is 100%; 17/20 (85%) obtained complete remission lasting 10--92 months, (median 48 months).

The clinical and morphologic characteristics of Kaposi's sarcomas of the conjunctiva

A 77-year-old woman with known Kaposi's sarcoma of one year's duration developed nodular lesions of her right palpebral conjunctiva. Biopsy confirmed sarcomatous involvement and local resection was performed. Despite leaving residual tumor, there was complete regression of the eyelid tumor three years after the resection. Electron microscopic studies characterize this neoplasm as a proliferation of primitive endothelial cells and pericytes, the two cell lines that compose a capillary wall.

Radiotherapy of Kaposi's sarcoma

Between 1958 and 1976, 34 patients with Kaposi's sarcoma were seen. Two patients were kidney transplant recipients. Co-existing malignancies were seen in 22% of patients. From 1958 to 1965, cutaneous lesions were treated solely with local radiotherapy techniques, single doses of 800 rads being found adequate to produce a complete response. In 1965, because of the multicentric occurrence of the disease and frequent recurrences after local radiotherapy techniques, extended field radiotherapy was begun. Ten of twelve patients thus treated responded completely. It is concluded that extended field radiotherapy using a single dose of 800 rads offers complete relief of symptoms and better control of the disease when compared to local radiotherapy. There was very little morbidity, with the extended field technique.

Radiotherapy in the management of Kaposi's sarcoma in Nigeria

Although Kaposi's sarcoma is now known to be far more common in the black African than was originally thought, it is rare in Nigeria. Facilities for radiotherapy are not available in areas of Africa where this condition occurs frequently. Various chemotherapeutic agents have been used either singly or in combination, with different results. In the locally confined lesions, it is believed that radiotherapy has an edge over the use of cytotoxic drugs. Five patients were seen and treated with radiation at the Lagos University Teaching Hospital in five years. They were all males, adults and came from the southern part of the country. All had histological confirmation of their disease as well as full investigations. Their histories are briefly reported. Response to chemotherapy from the literature has been discussed in order to highlight similar peculiarities attending the use of radiation on the normal tissues of the limbs. Ten different dose--time relationships were used on the five patients and these were plotted on double log scale. The results show that good response to curative radiotherapy varies inversely with the duration of the disease.

Kaposi's sarcoma of the conjunctiva

A 75-year-old man with known Kaposi's sarcoma of three-years' duration developed chronic hemorrhagic thickening of the conjunctiva. Biopsy demonstrated histopathologically that the conjunctiva thickening represented sarcoma involvement. Although surgically untenable, the conjunctival lesion responds satisfactorily to radiotherapy.

Diseases of Jews

The relative social and genetic isolation of Jews from other communities, which was much more marked in the past than now, has led to the belief that they are unusually prone to a variety of illnesses. Until the last few decades assessments of the incidence of various diseases among them were usually based on impressions rather than planned surveys or careful analyses, and many misconceptions still persist. It is proposed to consider the present state of knowledge as well as to indicate the historical and social basis for any tendencies for Jews to suffer from, or perhaps to resist, some diseases. No attempt has been made to analyse every single report in which Jewish pre-disposition to various diseases is mentioned; attention will be focused on those conditions that have received greater attention or from which it is possible to draw meaningful conclusions.