RADIOTHERAPY IN THE MANAGEMENT OF EPIDEMIC KAPOSIS-SARCOMA

Purpose: This study is presented to help define the role of radiothera py in the management of epidemic Kaposi's sarcoma. Methods and Materia ls: Between June 1986 and June 1993, we treated 453 patients who had a cquired immunodeficiency syndrome related Kaposi's sarcoma. Two hundre d fifty-two patients (55.6%) had received previous treatment for their Kaposi's sarcoma: 228 (55.3%) with interferon, and 116 (25.6%) with V inblastine. Depending on both tumour size and location, patients were treated with extended cutaneous irradiation using 4 MeV electron beam energy and/or localized irradiation using 45-100 kV x-ray (cutaneous l esions), or 4 Mn x-ray (oral tumours). A total of 5015 courses of radi ation therapy was given. The intention of the treatment was closely li nked to the anatomic sites. Multiple courses of treatment ranging from 10 to 20 Gy (2.5 Gy/fraction, 4 times/week) were used for Kaposi's sa rcoma involving conjunctiva (n = 32 treatments), eyelids (n = 306), li ps (n = 170), hands (n = 208), feet (n = 417), penis (n = 131), oral m ucosa (n = 43), and anal region (n = 5). A-second group including othe r cutaneous sites (face, trunk, limbs) was treated with a dose of 30 G y (20 Gy in 2 weeks followed by 2 weeks rest and then a second series of 10 Gy in 1 week). Results: For the first group, tolerance was gener ally good excluding oral cavity irradiation, with an effective palliat ion of symptoms (87.8% overall rate of objective responses); an enhanc ed mucosal reactions was noted in patients receiving oropharyngeal irr adiation. For the second group, a complete regression rate of 85% was observed; tolerance was acceptable: complications were severe epidermi tis with skin ulceration (5%), exsudative epidermitis (26%), dry epide rmitis (60%), and varying degrees of erythema (9%). There was a signif icant correlation between risk of recurrence (overall recurrence rate of 71% after an average of 7.5 months) and occurrence of opportunistic infections: 85% of recurrences appeared concomitantly with accelerate d course of acquired immunodeficiency syndrome. Conclusions: We conclu de that radiotherapy is an efficient treatment for epidemic Kaposi's s arcoma (EKS): doses of 15.2 Gy for oral lesions and 20 Gy for lesions involving conjunctiva, eyelids, lips, hands, feet, penis, and anal reg ion were sufficient to produce shrinkage of the tumour and good pallia tion of symptoms. For the other cutaneous sites, 30 Gy local field irr adiation could be safely given with better short-term response. Prophy lactic measures with antifungal treatment should be systematically ass ociated with oropharyngeal irradiation, to improve tolerance to the tr eatment.