Radiotherapy in the Management of Kaposi’s Sarcoma

Abstract

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.

Imiquimod 5% cream for treatment of HIV-negative Kaposi's sarcoma skin lesions: A phase I to II, open-label trial in 17 patients

“…The median number of treated lesions per patient was 5 (range Q1-Q3: 3-6). Before treatment, the median tumor area per patient was 1658 mm 2 (range Q1-Q3: 399-2365) and median sum of the infiltration score per patient was 5 (range Q1-Q3: [3][4][5][6][7][8].…”

“…Local therapies, such as radiation, 8 cryotherapy, intralesion vinblastine sulfate, and laser ablation are useful, but they require administration by physicians and may cause pain, scarring, ulceration, or unwanted changes in pigmentation. Apart from topical 9-cis-retinoid acid, which, in association with highly active antiretroviral therapy, results in 37% partial response (PR) or total response in HIV-related KS (treatment that has not been evaluated in classic KS), 9 no simple self-administered topical treatment is currently available for KS.…”

Retrospective Analysis of 91 Kaposi’s Sarcoma Cases: A Single-Center Experience and Review of the Literature

“…If there is a single symptomatic lesion, excision may provide local tumor control [5]. Radiotherapy is effective and often represents the best local treatment, with response and complete remission rates of more than 90 and 70%, respectively [33]. However, various chemotherapeutic drugs have been used in CKS [34].…”

Unusual Eyelid, Periocular, and Periorbital Cutaneous Malignancies

“…Higher total doses of radiotherapy (>20 Gy) seem to be associated with a higher response rate and a longer duration of tumor control. 15 However, one prospective study found no difference in the initial response between 16 Gy delivered over 4 fractions versus a single 8 Gy treatment in 596 KS lesions. 14 Despite the high-initial response rate to various doses of radiotherapy, it should be kept in mind that 30% to 50% of patients experience tumor recurrences with the follow-up of 6 months or more.…”

“…4 Radiotherapy is a highly effective local or regional treatment option for KS, with total doses between 20 and 30 Gy leading to an initial response rate of 90% to 100%. 4,14,15 The dose and regimen of radiotherapy used for KS in the literature varies widely. Higher total doses of radiotherapy (>20 Gy) seem to be associated with a higher response rate and a longer duration of tumor control.…”