Oral cavity and oropharyngeal tumors in human immunodeficiency virus-positive patients - Acute response to radiation therapy

Background: The survival of patients with human immunodeficiency virus (HIV ) has improved considerably with modern medical management. However, there remains surprisingly little information on treating head and neck neoplasms in HIV-positive patients. Objective: To report our recent experience treating oral cavity and orophar yngeal tumors in HIV-positive patients. Design and Patients: Retrospective analysis of a cohort of 8 HIV-positive p atients with Kaposi sarcoma (KS), lymphoma, or squamous carcinoma of the or al cavity or oropharynx who were consecutively treated during a single year with radiation therapy at a tertiary care referral center. Length of follo w-up was at least 2 years (mean, 2.5 years). Results: All patients had partial and complete responses to treatment lasti ng until the last follow-up. However, we found that treatment was considera bly better tolerated by patients with non-KS tumors, with fewer acute react ions and significantly less weight loss, despite larger treatment volumes a nd higher radiation doses, compared with patients with KS. Patients with no n-KS tumors received a mean radiation dose of 62.6 Gy to 2636 cm(3), yet lo st only a mean of 0.1 kg in weight, whereas patients with KS were treated w ith a mean radiation dose of 19 Gy to a mean volume of 568 cm(3), but lost a mean of 5.8 kg during treatment (P =.005) and on average sustained an add itional grade of severity on a standard scale of mucosal reaction (P =.01). Conclusions: Oral cavity and oropharyngeal tumors in HIV-positive patients respond to radiation therapy, but there is a marked difference in the degre e of acute reactions to treatment between patients with and without KS. Inf ection with HIV is not a contraindication when aggressive radiation therapy is needed in select patients.