Radiotherapy for Kaposi's Sarcoma

Abstract

Kaposi's sarcoma is a malignancy for which there is no satisfactory standardized, nor even a very good, method of treatment. When the condition is indolent and but slowly progressive on the feet, where it is most common, conservative measures of good local hygiene and palliation of edema, if present, by mechanical support of circulation by elastic garments is generally advised. Small, dispersed nodules on the feet or hands, if symptomatic or subject to trauma, are amenable to extirpation by minor surgical procedures. When, however, the disease becomes continuous, symptomatic, extensive, or rapidly progressive and threatens to become disabling, radiotherapy is a first and best treatment. Helpful as radiotherapy may be in such cases, it is not and cannot be expected to be curative because it is practiced only on limited areas of clinically evident process and in that way does not influence the unpredictable rate of progression nor prevents development of multicentric foci of the disease in its capricious course. It is suggested that widespread radiotherapy in conservative doses be accorded early and prophylactically in cases of Kaposi's sarcoma immediately upon diagnosis and surely upon threat of rapid progression. There is precedent for such treatment in the extensive radiation practiced in Hodgkin's disease. Such treatment may prevent or at least halt progression of Kaposi's sarcoma by affecting clinically undetectable, active foci and foci in potential of malignant transformation. It can be designed to do no harm.

Argon Laser Photocoagulative Therapy of Kaposi's Sarcoma: A Clinical and Histologic Evaluation

“…Many approaches currently exist for the treatment of classic KS, but none can reliably provide a cure for this multicentric disease 53–57 of apparent endothelial cell origin 58 . For the most aggressive forms of KS, characterized by large, ulcerative, exophytic, cutaneous tumors that infiltrate underlying subcutaneous tissue or bone, local therapy including surgery, 44,45 radiation, 20–24 or intralesional chemotherapeutic agents 28,30 is the usual approach. Systemic therapy may be necessary, depending upon the extent of the disease since the 3‐year survival rate is only 64% in the common African form.…”

“…A variety of treatment modalities for KS have been used in the past with varying degrees of success. Some of these include: radiotherapy; 20–24 hyperthermia; 25 chemotherapy 26 using such agents as nitrogen mustard, 27 vinblastine, 28,29 vincristine, 30,31 DTIC, 32 bleomycin, 33 rezoxane, 34 etoposide, 35 cyclophosphamide, 36 BCNU, doxorubicin, 37 and dapsone; 38 immunotherapy; 39,40 interferon; 41–43 surgical excision and amputation; 44,45 ruby laser; 46 and, photodynamic therapy using a dye laser 47,48 …”

Oropharyngeal Kaposi's sarcoma

“…The present view is to use more extensive and aggressive radiotherapy in the initial stages so as to halt the progression or even achieve the 'cure' (Borock et al, 1979;Holecek and Harwood, 1978).…”

Evaluation of treatment plans using various treatment techniques for the radiotherapy of cutaneous Kaposi's sarcoma developed on the skin of feet

“…Even though the percentage of acquired immune deficiency syndrome (AIDS) patients with KS is decreasing, the overall incidence of epidemic KS is increasing along with the rising prevalence of AIDS (3) . It has been well established that KS is responsive to radiation therapy, and in response various radiation treatment schemes have been studied 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 . The response rate of KS in epidemic form to radiation therapy has been demonstrated to be as high as 90%, and it has been proven that radiation therapy shows better symptomatic control than chemotherapy (14) …”