Correspondence

Periorbital Edema in Kaposi's Sarcoma

N Engl J Med 1995; 333:799-800September 21, 1995

Article

To the Editor:

As Dr. Zidar notes in the legend accompanying the image of periorbital edema associated with AIDS-related Kaposi's sarcoma (May 4 issue),1 edema is a common problem in patients with AIDS-associated Kaposi's sarcoma, especially those with advanced disease, with up to one fifth of patients having this problem.2,3

Edema is not, however, an absolute indication for systemic chemotherapy — especially a regimen as toxic as the combination of doxorubicin, bleomycin, and vincristine. We find that in the absence of other problems associated with Kaposi's sarcoma, periorbital edema responds well to local, wide-field, megavoltage irradiation. Systemic chemotherapy often condemns patients to a continuous regimen, and to its toxic effects, for the rest of their short lives. Irradiation offers a means of local treatment without the systemic side effects of chemotherapy. In our opinion, irradiation also offers a quicker means of relieving symptoms, especially in patients whose vision is threatened.

A fractionation regimen such as 20 Gy delivered in 10 fractions during a two-week period, with the use of internal eye shields, is easily tolerated, and marked symptomatic relief often occurs after only 2 or 3 fractions have been delivered. This approach also gives patients time to consider future options for therapy and, if the option of systemic therapy is chosen, allows time for base-line investigations to be properly completed.

A patient with other symptoms or signs of visceral or pulmonary Kaposi's sarcoma (i.e., abdominal pain or breathlessness) should, of course, receive the regimen of chemotherapy currently being used at the center where the patient is being treated. Radiotherapy still offers a quick means of relieving symptoms, especially if visual impairment is the main problem.

Mark Harrison, M.R.C.P.
David Tomlinson, M.R.C.P.
Simon Stewart, M.D.
St. Mary's Hospital, London W2 1NY, United Kingdom

3 References

1. 1

   Zidar BL. Periorbital edema in Kaposi's sarcoma. N Engl J Med 1995;332:1204-1204
   Full Text | Web of Science | Medline

2. 2

   Bayley AC. Occurrence, clinical behaviour and management of Kaposi's sarcoma in Zambia. Cancer Surv 1991;10:53-71
   Medline

3. 3

   Harrison M, Tomlinson D, Stewart S. Liposomal-entrapped doxorubicin: an active agent in AIDS-related Kaposi's sarcoma. J Clin Oncol 1995;13:914-920
   Web of Science | Medline

Author/Editor Response

Dr. Zidar replies:

To the Editor: The computed tomographic scans in our patient showed diffuse swelling not only of the periorbital area but also of the entire head and neck. Diffuse edema of the head, neck, and periorbital structures usually indicates serious involvement, with more aggressive and disseminated disease. We believe that this type of involvement is more amenable to systemic chemotherapy than to local irradiation, although we do not deny that in many cases of local edema, radiotherapy may be very effective. Unfortunately, there has not been a randomized trial comparing radiotherapy with chemotherapy in the treatment of edema related to Kaposi's sarcoma.

Radiotherapy, although effective, is not without its own inherent problems, including mucositis.1,2 Krigel and Friedman-Kien have noted that complications are frequently encountered in the presence of moderate-to-severe edema and that long-standing tumor lesions and extensive confluent areas of Kaposi's sarcoma have been found to have reduced radiosensitivity.3

Bernard L. Zidar, M.D.
Medical College of Pennsylvania–Hahnemann University, Pittsburgh, PA 15212

3 References

1. 1

   Levine AM, Crawford J. AIDS-related malignancies: 1993. Amgen Journal Club presentation.
   

2. 2

   Northfelt DW, Kahn JO, Volberding PA. Treatment of AIDS-related Kaposi's sarcoma. Hematol Oncol Clin North Am 1991;5:297-310
   Web of Science | Medline

3. 3

   Krigel RL, Friedman-Kien AE. Kaposi's sarcoma in AIDS: diagnosis and treatment. In: DeVita VT, Hellman S, Rosenberg SA, eds. AIDS: etiology, diagnosis and prevention. 2nd ed. Philadelphia: J.B. Lippincott, 1988:255.
   

Citing Articles (6)

Citing Articles

1. 1

   Petros I. Rafailidis, Matthew E. Falagas. (2007) Fever and Periorbital Edema: A Review. Survey of Ophthalmology 52:4, 422-433
   CrossRef

2. 2

   ES Atillasoy, A Santoro, JM Weinberg. (2001) Lymphoedema associated with Kaposi’s sarcoma. Journal of the European Academy of Dermatology and Venereology 15:4, 364-365
   CrossRef

3. 3

   Andrei Cucuianu, Mariana Patiu, Milena Duma, Carmen Basarab, Olga Soritau, Anca Bojan, Anca Vasilache, Mihaela Mates, Ljubomir Petrov. (1999) Hepatitis B and C virus infection in Romanian non-Hodgkin's lymphoma patients. British Journal of Haematology 107:2, 353-356
   CrossRef

4. 4

   Jonathan W. Said, Kai Chien, Taizo Tasaka, H. Phillip Koeffler. (1997) Ultrastructural characterization of human herpesvirus 8 (Kaposi's sarcoma- associated herpesvirus) in Kaposi's sarcoma lesions: electron microscopy permits distinction from cytomegalovirus (CMV). The Journal of Pathology 182:3, 273-281
   CrossRef

5. 5

   Jonathan W. Said, Taizo Tasaka, Sven de Vos, H Phillip Koeffler. (1997) Kaposiʼs sarcoma-associated herpesvirus/human herpesvirus type 8 encephalitis in HIV-positive and -negative individuals. AIDS 11:9, 1119-1122
   CrossRef

6. 6

   William DePond, Jonathan W. Said, Taizo Tasaka, Sven de Vos, Douglas Kahn, Ethel Cesarman, Daniel M. Knowles, H. Phillip Koeffler. (1997) Kaposi's Sarcoma-Associated Herpesvirus and Human Herpesvirus 8 (KSHV/HHV8)-Associated Lymphoma of the Bowel. The American Journal of Surgical Pathology 21:6, 719-724
   CrossRef