RADIOTHERAPY IN THE MANAGEMENT OF EPIDEMIC KAPOSIS-SARCOMA - A RETROSPECTIVE STUDY OF 643 CASES

Purpose: To report to the literature the largest published series of e pidemic Kaposi's sarcoma (EKS), treated with radiation therapy, to sum marize and discuss our 10 years experience in the treatment of this ma lignancy. Methods and materials: From June 1986 to December 1996, 643 patients with acquired immunodeficiency syndrome (AIDS)-related epidem ic Kaposi's sarcoma were treated with radiation therapy (RT) at the Ca ncerology Department of Henri Mondor University Hospital. The patients , 640 men and 3 women had an average age of 38.5 years (range 20-68 ye ars). Three hundred eighty-seven patients (60.14) had received previou s treatment for their Kaposi's sarcoma (KS). In total, 6777 fields wer e irradiated, as follows: face 1342 (19.8%), eyelid and conjunctiva 36 2 (5.3%), trunk 1903 (28.1%), upper and lower limbs 2866 (42.3%), geni tals 189 (2.8%), and oral cavity 115 fields (1.7%). Radiation therapy consisted of 4 MV or 45-70 kV X-rays, depending on tumor size and loca tion. Doses ranged from 10 to 30 Gy, according to tumor response and t oxicity. Results: Objective response (CR and PR) was observed in 92% ( 5947/6464) of all cases, treated for cutaneous form of EKS. All patien ts with irradiated oral lesions had an objective response. The overall tolerance was acceptable for the cutaneous lesions. By contrast, in o ral lesions, mucosal reactions were often observed after relatively lo w doses of radiotherapy. Conclusions: Doses of 15 Gy for oral lesions, 20 Gy for lesions involving eyelids, conjunctiva, and genitals, have been shown to be sufficient to produce shrinkage of the tumor and good palliation of the symptoms. For the cutaneous EKS, we propose 30 Gy g iven in a local field, using a fractionated scheme with small size app licators. Radiotherapy has its own place in the management of EKS, as an efficient treatment. (C) 1998 Elsevier Science Ireland Ltd.