Oral cavity and oropharyngeal tumors in human immunodeficiency virus-positive patients: acute response to radiation therapy.
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.


METHODS
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.
Kao
G D
GD
Department of Radiation Oncology, Philadelphia Veterans Affairs Medical Center, PA, USA. kao@xrt.upenn.edu
Devine
P
P
Mirza
N
N
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D015331:Cohort Studies; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy*; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D011836:Radiation Tolerance; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000532:radiotherapy*; D016896:Treatment Outcome