Kaposi's sarcoma in AIDS: the role of radiation therapy

[Radiotherapy of epidemic Kaposi's sarcoma: the experience of the Henri-Mondor Hospital (643 patients)]

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.

Role of radiotherapy in the treatment of epidemic Kaposi's sarcoma: experience with sixty-five cases

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.

Radiotherapy in the management of cutaneous epidemic Kaposi's sarcoma

Between June 1986 and December 1988, we treated 149 patients who had AIDS-related epidemic Kaposi's sarcoma with cutaneous irradiation. According to Mitsayasu's staging, 34 patients (23%) had Stage I disease, 82 (55%) Stage II, 0 Stage III, and 33 (22%) Stage IV. Fifty-eight patients (39%) had previously presented with one or more opportunistic infections. Ninety-four patients (63%) had received previous treatment of their Kaposi's sarcoma: 85 (57%) with interferon and 43 (29%) with vinblastine. Among the 149 patients, we treated 88 (59%) with extended cutaneous irradiation using 4- and/or 8-MeV electron beam energy and 61 patients (41%) with localized irradiation using 45-kVp x-ray energy. The total prescribed dose was 30 Gy: 20 Gy in 2 weeks (2.5 Gy/fraction, 4 times/week), followed by 2 weeks of no irradiation, and then 10 Gy in one week by the same dose schedule. Twenty patients (13%) with edema of the lower limbs were treated using 4-Mv photon therapy with bolus. Of the 131 evaluable patients, 63% achieved a complete remission (CR) and 30% a partial remission (PR) after a mean period of 1.5 months (range: 0.5-3 months). The clinical disease stage, anatomic site, and irradiation technique did not significantly influence the remission rates, although we noticed a higher CR rate when localized irradiation was used (71% vs 55.5% for localized and extended irradiation, respectively; p = 0.08). The overall tolerance was acceptable. Complications were severe epidermitis with skin ulcerations (8% of patients), exudative epidermitis (26%), dry epidermitis (60%), and varying degrees of erythema (6%). Of the 87 patients whose AIDS remained relatively clinically stable during the observation period, recurrences occurred in 56 (64%) after an average of 5.5 months (range: 1.5-12 months). We conclude that radiotherapy is useful and can be recommended as a palliative treatment to relieve pain and physical discomfort or to achieve cosmetic improvements for patients with epidemic Kaposi's sarcoma. We also conclude that radiotherapy is most beneficial in the early stages of disease, when localized treatment is practical.