RADIOTHERAPY IN THE MANAGEMENT OF EPIDEMIC KAPOSIS-SARCOMA OF THE ORAL CAVITY, THE EYELID AND THE GENITALS

From January 1987 to December 1992, 420 patients with acquired immunod eficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma (EKS) were treated with radiotherapy at the oncology department in the Henri Mon dor Hospital. Of these, 146 (34.7%) exhibited tumours at 186 sites; 35 were oral, 102 eyelid or conjunctival (ophthalmic), and 49 penile or scrotal (genital) sites. Most patients had received prior chemotherapy . Radiation therapy consisted of 4 MV or 45 kV X-rays, depending on tu mor size and location. Doses ranged from 10 to 30 Gy, according to tum or response and toxicity. In oral lesions mucosal reactions were often observed after relatively low doses of radiotherapy. In 27 patients r eceiving 15 Gy, severe reactions were observed in 6 (22%), moderate re actions in 4 (15%) and mild reactions in 17 (63%). By contrast, irradi ation of eyelid or conjunctival lesions and genital lesions was well-t olerated. Treatment was generally successful in achieving good symptom palliation. Eyelid and conjunctival Kaposi's sarcoma seemed to be mor e radiosensitive when compared with cutaneous sites: a high objective remission rate (96%, 98/102) was observed at doses ranging from 10 to 20 Gy. Penile and scrotal lesions showed a good response to low dose r adiation (complete response was scored in 34/49 patients (69.4%)). A m eticulous evaluation of tolerance was necessary. Toxicity of oropharyn geal irradiation at relatively low doses is an argument for a restrict ive use of this procedure in oral lesions.