Intracavitary contact X-ray therapy of oral HIV-associated Kaposi's sarcoma

Abstract

A retrospective study was performed to assess the efficacy and low mucosal toxicity of intracavitary contact X-ray therapy (ICRT), a proposed treatment of small/medium sized lesions of oral HIV-associated Kaposi's sarcoma (HIV-KS). Twenty-six patients with histologically confirmed oral HIV-KS underwent ICRT in the period 1986-1995. No patient received antiblastic or interferon therapy during the radiotherapy or follow-up periods. ICRT was performed according to the usual technical modalities of contact X-ray therapy, but the end of the source of ionizing radiations was introduced into the oral cavity. The total doses administered ranged from 10 to 50 Gy per field, in one or two weekly fractions of 5 Gy each. The follow-up ranged from 1 to 44 months (mean 7.5 months). Complete remission was obtained in 20 cases (76.92%), partial remission in 6 (23.08%) and relapse in one case (3.84%). Pain was relieved in all cases. Mucosal reaction was mild and did not result in any interruption of treatment. Our data suggest that ICRT is an effective and well tolerated treatment. It can be used in the management of oral HIV-KS instead of external radiotherapy, provided that the size and the location of the lesions and the conformation of the palate are suitable to this technique.

Radiotherapy of classic and human immunodeficiency virus‐related Kaposi's sarcoma: results in 1482 lesions

“…The study done on a relevant number of irradiated lesions and with a long follow-up has made us to confirm and define better some observations reported in previous articles of ours on the topic. [7][8][9] Even if with different intentions, curative as far as possible in spite of the multicentric features for Mediterranean KS, and palliative or reducing the extent of the disease in HIV-related KS, radiotherapy has confirmed to be a safe and effective method, as established by some of the most reliable reports of the literature. [10][11][12][13] On the other hand, it has been frequently observed that patients treated with extended field irradiation suffer from severe skin reactions (exudative epidermitis with skin ulcerations) in 5% of cases.…”

Oral Kaposi's sarcoma: a review and update

“…However, radiation‐induced oral toxicities, such as severe mucositis, impaired salivary gland function, taste disturbances, and the exacerbation of oral infections frequently develop early in the course of therapy and with relatively low doses of radiation, necessitating palliative measures . Modified radiotherapy techniques such as intracavitary contact radiation, by contrast, have been efficacious in the treatment of OKS and are associated with negligible mucositis . In current practice, external beam radiotherapy is generally reserved for the treatment of symptomatic or obstructive oropharyngeal KS …”

“…44 Modified radiotherapy techniques such as intracavitary contact radiation, by contrast, have been efficacious in the treatment of OKS and are associated with negligible mucositis. 45 In current practice, external beam radiotherapy is generally reserved for the treatment of symptomatic or obstructive oropharyngeal KS. 20,44 Although local and regional OKS may respond to conservative measures, symptomatic OKS, epidemic OKS that is unresponsive to HAART, and disease that has disseminated to visceral organs often require systemic intervention.…”

Kaposi’s Sarcoma – Radiotherapeutic Aspects

“…Margaretic et al [17] describe the successful use of total skin electron treatment for extensive cutaneous lesions. For mucosal foci, Caccialanza et al [18] reported an intracavitary X-ray therapy using soft X-rays whereas Syndikus et al [19] applied brachytherapy to the hard and soft gum using individual dental plates.…”