Palliative treatment for HIV-related Kaposi's sarcoma
Date
2003
Authors
Barnardt P.
Georgiev G.D.
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Volume Title
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Abstract
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.
Description
Keywords
anthracycline derivative, antiretrovirus agent, bleomycin, CD4 antigen, cotrimoxazole, doxorubicin, paclitaxel, proteinase inhibitor, vinblastine, vincristine, acquired immune deficiency syndrome, adult, article, bleeding, blood toxicity, cancer chemotherapy, cancer growth, cancer mortality, cancer staging, cancer survival, controlled study, drug choice, drug response, drug tolerability, female, human, Human immunodeficiency virus infection, Kaposi sarcoma, major clinical study, male, neutropenia, opportunistic infection, palliative therapy, Pneumocystis pneumonia, prognosis, radiation dose, ulcer
Citation
Southern African Journal of HIV Medicine
13
13