Kaposi's+Sarcoma

Although KS has been reported among all risk groups for HIV infection, it is most common in homosexual or bisexual men. As reported to the CDC, AIDS-related KS is seen with the following frequencies in various groups of HIV-infected patients: The fraction of AIDS cases presenting as KS has decreased since the beginning of the AIDS epidemic, as illustrated by the following: __Tumor (T) __ - confined to skin and/or lymph nodes and/or minimal oral disease (Note Minimal oral disease is non-nodular KS confined to the palate.) __Immune system __ (I) - CD4 cells >=/microL __Systemic illness __(S) - No history of Ols thrush (note: Ols are opportunistic infections.)  No “B” symptoms (note: “B” symptoms are unexplained fever, night sweats, >10% involuntary weight loss, or diarrhea persisting > 2 weeks .  Performance status > or = to 70 (Karnofsky)  __Tumor (T) __  - tumor-associated edema or ulceration, extensive oral KS, gastrointestinal KS, KS in other non-nodal viscera.  __Immune system (I) __  - CD4 cells <200 per cubic millimeter __Systemic illnesses (S) __ - History of Ols and/or thrush, “B” symptoms are present, performance status < 70, other HIV-related illness (e.g., neurological disease or lymphoma)⁴ || Radiation therapy is considered the treatment of choice with the best cosmetic result. Other options include surgery, laser, topical chemotherapy, and frozen liquid nitrogen. Watch-and-wait is advised for widespread, asymptomatic disease. Rapidly progressive or life-threatening disease should be treated with a combination of vincristine and actinomycin D, for a near 100% response rate. Radiation therapy Local irradiation should include the lesion plus a 1.5-2cm border. Thin cutaneous lesions should be treated with beam energies of either superficial x-rays or 4-6MeV electrons with bolus. Thick plaques or nodules are best treated with higher energy electrons. Eyelids are best treated with superficial x-rays and protective shield over the lens. When there is substantial swelling, photons with parallel opposed fields are recommended along with bolus material or a water bath. Dose should be delivered to midline. Dose for healthy patients should be 30 Gy in 10 fractions for small lesions. Larger lesions and less healthy people should be treated with one fraction of 8 Gy. Because recurrence may appear in tissues adjacent to treated areas, elective use of wide-field MV photons with bolus is warranted.¹¹ || TD 5/5 for the Typical Kaposi's Sarcoma Sites 8 || Figure 1 Water Bath Technique for Foot 9 __References__ ** 1. Yuhan KR, You T. //Kaposi Sarcoma//. Available at: [|//http://emedicine.medscape.com/article/1197815-overview//]//.// Accessed February 15, 2010. 2. Yuhan KR, You T. //Kaposi Sarcoma//. Available at: [|//http://emedicine.medscape.com/article/1197815-overview//]//.// Accessed February 15, 2010. 3. Yuhan KR, You T. //Kaposi Sarcoma//. Available at: [|//http://emedicine.medscape.com/article/1197815-overview//]//.// Accessed February 15, 2010. 4. [|www.cancer.gov/cancertopics/pdq/treatment/kaposi.com]. Accessed Febuary 24, 2010 5. [|www.cancer.org/Kaposi] Accessed Febuary 16, 2010 6. []. Accessed on Febuary 15 2010 7. [] Accessed February 18, 2010 8. Wikibooks en.wikibooks.org TD5/5 adapted from Emami 1991 9. Faiz M. Khan. //Treatment Planning in Radiation Oncology//. 2nd ed. Philadelphia, PA Lippincott Williams & Wilkins. 2007  10. Washington CM, Leaver D. // Principles and Practice of Radiation Therapy //. 2nd ed. St. Louis, MO: Mosby. 2004 11. Chao KS, Perez CA, Brady LW. //Radiation Oncology-Management Decisions//. 2nd ed. Philadelphia, PA: Lippincot, Williams & Wilkins; 2003
 * < Epidemiology: || Kaposi's Sarcoma (KS) is principally a disease of men. The incidence of KS, both classic and AIDS-related forms, is approximately 15 times greater in men than in women.
 * Homosexual men — 20 to 30 percent
 * Heterosexual injection drug users (IDU) — 3 percent
 * Transfusion recipients — 3 percent
 * Women or children — 3 percent
 * Hemophiliacs —1 percent
 * Among gay or bisexual AIDS patients in the United States, the proportion presenting with KS decreased from 40 percent in 1983 to 13 percent in 1988. This change was attributed to safer sexual practices and as a consequence of anti-HIV therapy.
 * In data derived from nine population-based cancer registries reporting to the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, changes in incidence rates of KS over a 25 year period were most evident in San Francisco. KS rates among white men had risen from 0.5 per 100,000 people per year in 1973, to between 31.3 and 33.3 from 1987 through 1991, and then declined to 2.8 in 1998.
 * Since the introduction of HAART, the incidence of KS has declined markedly in HIV-infected patients. The dramatic impact of HAART on the incidence of KS is illustrated by an analysis of more than 375,000 people with AIDS, in which the incidence of various cancers was analyzed. The standardized incidence ratio (SIR) for KS compared to the general population fell from 22,100 to 3640 with the widespread use of HAART.
 * Similarly, a combined analysis of 47,936 HIV-positive individuals from North America, Europe, and Australia showed a decline in adjusted incidence rates for KS from 15.2 to 4.9 cases per 1000 person-years between the time periods 1992 to 1996 and 1997 to 1999, respectively. 7 ||
 * < Etiology: || The etiology of classic Kaposi's Sarcoma (KS) and AIDS-related KS is unknown. There is information suggesting a link between KS and the human herpes virus 8 (HHV8). KS is the most common malignancy in people with AIDS. 1 ||
 * < Signs & Symptoms: || * <span style="color: #ff00ff; font-family: 'Times New Roman','serif';">Lesions in the mouth and/or throat
 * <span style="color: #ff00ff; font-family: 'Times New Roman','serif';">Slightly elevated purple, pink, brown, or red lesions appearing anywhere on the skin
 * <span style="color: #ff00ff; font-family: 'Times New Roman','serif';">Lymphedema (swelling due to blockage of the lymph system)
 * <span style="color: #ff00ff; font-family: 'Times New Roman','serif';">Unexplained cough or chest pain
 * <span style="color: #ff00ff; font-family: 'Times New Roman','serif';">Unexplained stomach or intestinal pain
 * <span style="color: #ff00ff; font-family: 'Times New Roman','serif';">Diarrhea and/or blockage of the digestive tract, caused by Kaposi’s sarcoma lesions that have developed in the gastrointestinal system⁴ ||
 * < Diagnostic Procedures: || Diagnostic procedures for both classic and epidemic KS include a complete history and physical along with a biopsy of one the lesions. All visible skin and mucosal surfaces should be examined. An HIV test should be obtained along with complete blood tests. If the patient is AIDS related and gastrointestinal or respiratory symptoms exist, endoscopic studies of these systems should be obtained. Medical imaging does not play a large role in KS. 2 ||
 * < Histology: || There are 4 variants of KS; however, all 4 present similar histologic characteristics. It consists of endothelium-lined vascular channels with a proliferation of spindle shaped cells which are surrounded by inflammatory cells. 3 ||
 * < Lymph Node Drainage: || No sources indicate that lymph node drainage plays a role in KS. ||
 * < Metastatic Spread: || <span style="color: #ff00ff; font-family: 'Verdana','sans-serif'; font-size: 10pt;">Kaposi's Sarcoma can either spread locally and involve nearby tissues, i.e., spread to the cavity outside the lungs (pleural space) and layers around the heart, or travel to distant sites such as local lymph glands or the liver, bones, brain, or the opposite lung. Other organs where Kaposi's Sarcoma has a tendency to spread are the Adrenal glands, which are the glands located above the kidneys. These glands produce special hormones. Another area where the cancer may spread is the area near the spinal cord and vertebrae.⁶ ||
 * < Grading: || <span style="color: #ff00ff; font-family: 'Times New Roman','serif';">Kaposi's sarcoma (KS) is a low-grade vascular tumor associated with human herpesvirus 8 (HHV-8), also known as the KS-associated herpesvirus (KSHV).⁴ ||
 * < Staging: ||
 * <span style="color: black; font-family: 'Times New Roman','serif';"> Good Risk (0) **
 * <span style="color: black; font-family: 'Times New Roman','serif';"> Poor Risk (1) **
 * < Radiation Side Effects: || Skin erythema, itching, nausea, vomiting. Tiredness and lack of energy are potential side effects.¹⁰ ||
 * < Prognosis: || Prognosis is good with complete remission achieved in 68% of patients treated with wide field technique. 43% of these patients remain disease free. For patients treated with local-field irradiation, 65% experience complete remission, but only 23% remain disease free.¹¹ ||
 * < Treatments: || Local therapy can provide long-term disease-free survival due to the slow growth of the disease.
 * < TD5/5: || [[image:Kaposi_TD5-5.JPG width="444" height="232"]]
 * [[image:Water_Bath_Foot.JPG]]