Palliative treatment for HIV-related Kaposi's sarcoma
Objective. To evaluate palliative treatment with chemotherapy and/or radiotherapy in patients with HIV-related Kaposi's sarcoma (KS). The primary end-point was symptom relief; the secondary end-point was tumour response to treatment and overall survival. Methods. This study includes 100 patients with HIV-related KS. Combination chemotherapy was administered with ABV (doxorubicin, bleomycin and vincristine) (33 patients), or vinblastine and bleomycin (Vbl-B) (48 patients), depending on the CD4+ count at presentation. Radiotherapy was administered to 31 patients. Results. Symptomatic relief was noted within 4 weeks of chemotherapy and response after 8 weeks. Twenty-nine patients (29%) had partial responses, 8 patients (8%) achieved complete responses, and 37 patients (37%) had stable disease. Twenty-six patients (26%) had disease progression. The response rate was 37%, with clinical benefit achieved in 74% of patients. Patients who received radiation therapy for bleeding and painful ulcers had complete responses. Twenty-seven patients (27%) received 8 Gray (Gy) single fractions. Two lower-half bodies (8 Gy) and one upper-half body (6 Gy) were irradiated. Five patients received a course of radiation for nasopharyngeal and skeletal lesions (20 Gy), rectal lesions (30 Gy) and an eyelid lesion (12 Gy). Forty-two patients (42%) are alive, with a median survival of 11.2 months (range 2 - 49 months). Fifty-eight patients (58%) died due to progression of HIV disease or associated opportunistic infections with a median overall survival of 8.8 months (range 1 - 31 months). Conclusion. In the absence of antiretroviral therapy the care and prognosis of HIV-related Kaposi's sarcoma remains dismal. However, symptomatic relief and an improved quality of life can still be offered.