Kaposi's+Sarcoma

A second group at risk for developing Kaposi’s sarcoma is transplant patients. [4] AIDS-associated Kaposi sarcoma generally occurs in young to middle aged adults (20-54 years) [3] Classic Kaposi sarcoma generally occurs in patients 50-70 years old. [3] || Survival Interval (Years) Rate 1 64.9 2 41.5  3 31  4 26.4  5 23.5  6 22.1  7 21  8 20.3  9 19.6  10 19.2 [8]  In countries where treatment of (HAART) Highly Active Antiretroviral Therapy, Kaposi’s sarcoma advances rapidly and can cause death in 6 months. [8] ||
 * **Epidemiolgy:** || Prior to the AIDS epidemic, Kaposi’s sarcoma was very rare, SEER reported 19 cases between 1975 and 1980, in males 25-54 years old. An aggressive form (AIDS-associated Kaposi’s sarcoma) emerged in 1981 that was seen in sexually active homosexual males, marking the beginning of the AIDS epidemic. The risk of Kaposi sarcoma among sexually active homosexual men is much higher than any other group. Presently, there are approximately 2500 cases of AIDS-associated Kaposi’s sarcoma diagnosed in the US annually. The highest rate of diagnosis is in African-American males (3 in 10,000), which is just slightly higher than rates for Hispanic, white and Asian men. [3]
 * **Etiology:** || caused by the Kaposi sarcoma herpesvirus (KSHV) [5] ||
 * **Signs & Symptoms:** || tends to form in several areas on the body at the same time, commonly showing up on the ankles or lower extremities first. [6] ||
 * **Diagnostic Procedures:** || The initial workup for diagnosing Kaposi’s sarcoma includes a complete medical history and a comprehensive physical examination. Due to close association with AIDS, the patient should be screened for HIV. Bronchoscopy is used when a KS is suspected inside the lungs. For KS suspected inside of the gastrointestinal tract a gastrointestinal endoscopy can be done. [7] ||
 * **Histology:** || Kaposi’s sarcoma is not considered as a true sarcoma. Unlike other sarcomas, it arises from a lymphatic endothelium and develops vascular channels that are filled with blood cells. This gives the appearance of bruising on the skin. Kaposi’s sarcoma tumor cells have an abnormally elongated shape known as spindle cells. This highly vascular tumor leaks blood cells into surrounding tissues and creates inflammation. [7] ||
 * **Lymph node drainage:** || There is no lymph node drainage of Kaposi’s sarcoma. ||
 * **Metastatic spread:** || May spread to the lungs, liver or gastrointensitnal tract. Metastatic Kaposi’s sarcoma is associated with major symptoms, such as bleeding in the gastrointestinal tract or difficulty breathing due to lung metastases. ||
 * **Grading:** || Kaposi’s sarcoma is a low grade vascular tumor associated with human herpesvirus-8 infection. [1] ||
 * **Staging:** || There is no accepted staging system for Kaposi’s sarcoma. Patients are grouped depending on which type of Kaposi’s sarcoma they have. ||
 * **Radiation side effects:** || Side effects of radiation therapy can include skin changes, nausea, vomiting and fatigue. Radiation therapy can also cause anemia as well as lower number of white blood cells, which increases the risk of infection. [2] ||
 * **Prognosis:** || SEER’s Relative Survival Kaposi’s Sarcoma
 * **Treatments:** || Treatments[8]

Systemic chemotherapy has been used for patients with advanced disease\ - Treatment protocols were developed with low dose chemotherapy to which EKS was responsive Doxorubicin, bleomycin, and vincristine (ABV) Liposomal daunorubicin and doxorubicin - Has been compared with ABV and showed at least comparable activity with more favorable toxicity profile - Liposomal drugs now generally used as first-line therapy Paclitaxel is also approved for treatment Rarely, surgery is used for palliation Cryotherapy (liquid nitrogen) for small lesions

Kaposi Sarcoma Cancer

Intralesional injections of vinblastine Alitretinon gel is a noninvasive alternative Radiation therapy is used for palliation of pain, bleeding, or edema -Small fields that include only the lesion and a small margin -Superficial x-rays or electrons and bolus -3000 cGy in 10 fractions over 2 weeks - 800 cGy in one fraction for patients who have advanced AIDS || Interest Heart
 * **TD 5/5:** || [8] Kaposi’s Sarcoma || Organ of

Lung

Skin

Oral Mucosa || TD 5/5 1/3

6,000 cGy

4,500 cGy

7,000 cGy 10cm2

-- || TD 5/5 2/3 TD 3/3

4,500 cGy

3,000 cGy

6,000 cGy 30cm2 || --

4,000 cGy

1,750 cGy

5,500 cGy 100cm2

6,000 cGy 50cm3 || Complication

Pericarditis

Pneumonitis

Ulceration/Necro sis

Ulcer/Fibrosis || ||  ||   ||   ||   ||   ||   || [2] Kaposi Sarcoma. American Cancer Society. http://www.cancer.org/Cancer/KaposiSarcoma/DetailedGuide/kaposi-sarcoma-treating-radiation-therapy. Accessed July 3, 2012. [3] Medscape website.[|http://emedicine.medscape.com/article/279734-overview#a0199] Last updated August 5, 2011. Accessed July 5, 2012. [4] American Cancer Society website. [] Last updated January 24, 2012. Accessed July 5, 2012. [5] American Cancer Society website. [] Last updated January 24, 2012. Accessed July 6, 2012. [6] American Cancer Society website. [] Last updated January 24, 2012. Accessed July 6, 2012. [7] Hoppe TR, Phillips LT, Roach M. //Leibel and Phillips Textbook of Radiation Oncology//. 3rd Edition. Philadelphia, PA: Elsevie;. 2010. [8] Chaos KS, Perez CA, Brady LW. //Radiation Oncology-Management Decisions//. 2nd edition. Philadelphia:Lippincott, Williams & Wilkins. 2002 || Back to Week 7
 * **References:** || [1] Kaposi's Sarcoma. Texas Oncology. http://www.texasoncology.com/types-of-cancer/sarcoma/kaposis-sarcoma/. Accessed July 3, 2012.