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Acute Response to Radiation Therapy

Gary D. Kao, MD, PhD; Pamela Devine, MSN; Natasha Mirza, MD

Arch Otolaryngol Head Neck Surg. 1999;125:873-876.

Background  The survival of patients with human immunodeficiency virus (HIV) has improved considerably with modern medical management. However, there remains surprisingly little information on treating head and neck neoplasms in HIV-positive patients.

Objective  To report our recent experience treating oral cavity and oropharyngeal tumors in HIV-positive patients.

Design and Patients  Retrospective analysis of a cohort of 8 HIV-positive patients with Kaposi sarcoma (KS), lymphoma, or squamous carcinoma of the oral cavity or oropharynx who were consecutively treated during a single year with radiation therapy at a tertiary care referral center. Length of follow-up was at least 2 years (mean, 2.5 years).

Results  All patients had partial and complete responses to treatment lasting until the last follow-up. However, we found that treatment was considerably better tolerated by patients with non-KS tumors, with fewer acute reactions and significantly less weight loss, despite larger treatment volumes and higher radiation doses, compared with patients with KS. Patients with non-KS tumors received a mean radiation dose of 62.6 Gy to 2636 cm³, yet lost only a mean of 0.1 kg in weight, whereas patients with KS were treated with a mean radiation dose of 19 Gy to a mean volume of 568 cm³, but lost a mean of 5.8 kg during treatment (P=.005) and on average sustained an additional grade of severity on a standard scale of mucosal reaction (P=.01).

Conclusions  Oral cavity and oropharyngeal tumors in HIV-positive patients respond to radiation therapy, but there is a marked difference in the degree of acute reactions to treatment between patients with and without KS. Infection with HIV is not a contraindication when aggressive radiation therapy is needed in select patients.

From the Departments of Radiation Oncology (Dr Kao and Ms Devine) and Otolaryngology and Head and Neck Surgery (Dr Mirza), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pa.

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