Radiotherapy gives high response rates in the treatment of cutaneous KS and is an effective local palliative therapy. In the absence of any placebo group, it is difficult to state with certainty that the responses are due solely to the treatment, but inclusion of a placebo or sham radiotherapy group would be ethically unjustifiable. The rates of complete response and duration of lesion control are higher with increasing total doses of radiotherapy in AIDS-related KS.20 However, in this group of patients prognosis is that of the underlying AIDS diagnosis. In the study of Harrison et al., for example, participating patients survived for only a median of 17 months. With the advent of HAART, however, prognosis for patients with AIDS may be improving.21 Treatment is given with palliative intent and cosmesis is an important endpoint.

Difficulties in comparing trials of radiotherapy in cutaneous KS are variation in the definitions of response and the subjective nature of assessment, particularly of lesion colour and nodularity. A lesion may flatten or reduce in size with treatment but haemosiderin within the skin may leave residual brown pigmentation, influencing the overall cosmetic outcome. Uniform criteria of response in future trials should include assessment of lesion flatness, size, residual pigmentation and tumour-associated oedema after therapy. Evaluation of the effect of radiotherapy on the surrounding skin is also important in the overall cosmetic outcome following treatment. Patients should be warned that radiotherapy might lead to depigmentation of the surrounding normal skin, producing a "halo" effect.

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