Implications for clinical practice

Radiotherapy can improve the appearance of cutaneous KS lesions and provide temporary local control. In the population with AIDS-related cutaneous KS, a single 8 Gy fraction of radiotherapy with superficial x rays or electrons gives a high response rate. Some good evidence indicates that higher response rates and a greater duration of local control are seen with fractionated radiotherapy courses to a higher total dose. However, fractionated regimens more often cause acute toxicity and require more visits to hospital. This matters particularly in a group whose prognosis depends on the course of the underlying AIDS, although with more effective antiretroviral therapy longer term local control may become increasingly important.

Interferons have multiple effects on immune function and cell proliferation, and may act synergistically in the treatment of AIDS-related KS with antiretroviral therapy. We found no systematic reviews of the use of interferon in AIDS-related KS. Early phase II trials demonstrated activity of interferon as monotherapy for AIDS-related KS before the advent of nucleoside reverse transcriptase inhibitors. One small randomised trial compared two doses of interferon alfa as monotherapy in AIDS-related KS.28 On the basis of in vitro studies suggesting synergy between interferon alfa and antiretroviral drugs, multiple subsequent phase II trials have examined the combination of interferon alfa and zidovudine in the treatment of AIDS-related KS. We found one randomised comparative trial of 108 patients with AIDS-related KS using zidovudine antiretroviral therapy combined with one of two different doses of interferon alfa.29 We found no placebo-controlled trials.

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