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Kaposi’s sarcoma (KS)

Kaposi’s sarcoma (KS)
Kaposi’s sarcoma (KS)

Introduction

It is a malignant tumour of angio–formative cells usually starting from the skin but occasionally involving many other organs of the body. Kaposi sarcoma can be primarily categorized into four types: epidemic of AIDS–related, immunocompromised, classic or sporadic, and endemic (African). Here we have non AIDS related (endemic) KS and AIDS related (epidemic) KS where the late is more common 80–85%.

Management:

Treatment is palliative irrespective of type and stage hence careful assessment and decision is required to choose the best palliative treatment. ARVs should be initiated in epidemic KS patients who have not started the treatment. Choice of palliation depends on clinical presentation and patient general condition.

Radiotherapy: Is the best palliative treatment in symptomatic patient with local or extensive disease.
• 8Gy single fraction for disease on limbs or lower half body
• 6Gy single fraction for upper half body
• Dose of 9Gy/3# is usually prescribed for lesions elsewhere.

Signs and Symptoms

Diagnostic criteria

KS presents as a firm, dark brown nodules or plaque in the skin. Usually more on the limbs In young children and those with immunodeficiency it presents as wide spread lymphadenopathy with or without skin lesions. Presence of B symptoms (fever, sweating and weight loss) is commonly associated with epidemic type. Clinical course can be indolent especially endemic KS or aggressive.

Investigation

• FBC,LFTs, Urea & Creatinine, HIV test (if positive CD4 count and viral load
• CXR, abdominal pelvic ultrasound or CT scan of chest, abdominal pelvic CT, Bronchoscopy and Endoscopy
• Skin biopsy for histological confirmation

Note: Histological appearance for all types is the same

Staging of KS: Epidemic Kaposi sarcoma use AIDS clinical trials group (ACTG) system and for endemic/classical Kaposi sarcoma use Mitsuyasu classification system

Treatment

  • Pharmacological

    Palliative chemotherapy is usually given in patient with generalized disease.

    Commonly used regimen is ABV.

    • Adriamycin IV 25 mg/m2 Day1 + Bleomycin IV 10 IU/m2 Day1+Vincristine IV 1.4mg/m2 (max.2mg)Day1 Give every 3 weeks for 6 –8 cycles
    • Paclitaxel IV 100mg/m2 Day1 every 2 weeks or docetaxel 75mg/m2 day1 every 3 weeks is given for persistent or recurrent after ABV.
  • Non-pharmacological

Prevention

Updated on,

5 Novemba 2020 10:14:24

References

1.STG

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