Different treatment options for Kaposi sarcoma (KS) were discussed in the previous section, "How is Kaposi sarcoma treated." Deciding which treatment to use depends on a number of factors, such as
- The type of KS (which helps predict how fast the disease may grow and spread)
- The number of lesions
- What kinds of problems the KS is causing
- The patient's health
These factors need to be considered because certain treatments, such as chemotherapy, can have serious side effects. Someone who is weak or sick from other problems may not be able to tolerate chemotherapy. In a case like this, the chemo may do more harm than good.
AIDS-related Kaposi sarcoma
For someone with AIDS, the most important part of KS treatment is to fight the HIV infection with modern anti-AIDS drug combinations. For many patients, KS lesions begin to get smaller as their immune function gets better. In some patients with AIDS, highly active antiretroviral therapy (HAART) may be the only treatment needed to treat the KS. HAART also helps AIDS patients live longer and feel better. Still, other treatments for KS may be needed to improve symptoms (like pain and swelling).
A local treatment may be used for a few skin or mouth lesions. KS tumors of the skin, mouth, or anus are sometimes treated with low-doses of radiation therapy. As a rule, doctors use radiation therapy to relieve symptoms or treat highly visible lesions. Sometimes radiation is given to patients who can't have chemotherapy because they are too weak or have poor liver function.
Chemotherapy may be added to HAART for patients with:
- Many skin or mouth lesions
- Severe swelling from KS (lymphedema)
- Lung lesions causing shortness of breath
- Lesions in the stomach and intestines that have caused anemia (low red blood cell count), weight loss, or other problems
For chemotherapy, paclitaxel or one of the liposomal anthracyclines is usually chosen, If those drugs do not work, other chemotherapy drugs can be tried (see the section, "Chemotherapy").
Classic Kaposi sarcoma
Classic KS grows and spreads slowly, so lesions are more often treated with surgery or one of the local treatments. Chemotherapy may be used for widespread skin lesions or advanced KS. KS is considered advanced if it has spread to the lymph nodes or affects the lungs or gastrointestinal tract. Liposomal anthracyclines or paclitaxel are the drugs most often used for chemotherapy. Radiation therapy is also an option for individual lesions or groups of lesions.
Transplant-related Kaposi sarcoma
Sometimes lesions disappear on their own if the drugs that suppress the immune system are changed or stopped. A drug called sirolimus may be used in place of another anti-rejection drug because it can make Kaposi lesions get smaller. Skin lesions can be treated with radiation therapy or a local treatment. Most doctors try to avoid giving people who have had organ transplants chemotherapy for KS. But some patients may agree to participate in clinical trials of new drugs.
Endemic Kaposi sarcoma
Because endemic KS occurs in poor countries, treatment options are often limited. When available, the same treatments given for classic KS may be used.
Kaposi sarcoma in HIV-negative men having sex with men
This form of the disease is similar to classic KS, only it occurs in younger men. It is treated like classic KS.
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