Advertisement

State of the art: Gastrointestinal malignancies in the human immunodeficiency virus (HIV) population

  • Mary Koshy
  • John Kauh
  • Clifford Gunthel
  • Melissa Joyner
  • Jerome Landry
  • Charles R. ThomasJr.Email author
Review

Abstract

The gastrointestinal tract is one of the most common sites for the development of primary neoplasms arising in patients with pre-existing infection with the human immunodeficiency virus (HIV). Over the past decade, new information on the clinical manifestation, natural history, treatment options, and related toxicity have been reported, mostly notably the integration of highly active antiretroviral therapy (HAART). The following is a concise review summarizing the current state-of-the-art for GI tract malignancies in the HIV-positive patient and is designed to assist the clinical oncology team in developing a rationale plan when caring for these patients.

Key Words

GI lymphoma extranodal lymphoma HIV AIDS-related malignancies anal cancer 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gervaz P, Allal AS, Villiger P, et al. Squamous cell carcinoma of the anus: another sexually transmitted disease. Swiss Med Wkly 2003;133:353–359.PubMedGoogle Scholar
  2. 2.
    American Cancer Society. Cancer Facts & Figures 2004. 2004:4.Google Scholar
  3. 3.
    Frisch M. On the etiology of anal squamous carcinoma. Dan Med Bull 2002;49:194–209.PubMedGoogle Scholar
  4. 4.
    Palefsky JM. Anal human papillomavirus infection and anal cancer in HIV-positive individuals: an emerging problem. Aids 1994;8:283–295.PubMedGoogle Scholar
  5. 5.
    Rabkin CS, Yellin F. Cancer incidence in a population with a high prevalence of infection with human immunodeficiency virus type 1. J Natl Cancer Inst 1994;86:1711–1716.PubMedGoogle Scholar
  6. 6.
    Daling JR, Madeleine MM, Johnson LG, et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer 2004;101:270–280.PubMedGoogle Scholar
  7. 7.
    Tseng HF, Morgenstern H, Mack TM, et al. Risk factors for anal cancer: results of a population-based case-control study. Cancer Causes Control 2003;14:837–846.PubMedGoogle Scholar
  8. 8.
    Daling JR, Weiss NS, Hislop TG, et al. Sexual practices, sexually transmitted diseases, and the incidence of anal cancer. N Engl J Med 1987;317:973–977.PubMedCrossRefGoogle Scholar
  9. 9.
    Holly EA, Whittemore AS, Aston DA, et al. Anal cancer incidence: genital warts, anal fissure or fistula, hemorrhoids, and smoking. J Natl Cancer Inst 1989;81:1726–1731.PubMedGoogle Scholar
  10. 10.
    Penn I. Cancers of the anogenital region in renal transplant recipients. Analysis of 65 cases. Cancer 1986;58:611–616.PubMedGoogle Scholar
  11. 11.
    Piketty C, Darragh TM, Da Costa M, et al. High prevalence of anal human papillomavirus infection and anal cancer precursors among HIV-infected persons in the absence of anal intercourse. Ann Intern Med 2003;138:453–459.PubMedGoogle Scholar
  12. 12.
    Durante AJ, Williams AB, Da Costa M, et al. Incidence of anal cytological abnormalities in a cohort of human immunodeficiency virus-infected women. Cancer Epidemiol Biomarkers Prev 2003;12:638–642.PubMedGoogle Scholar
  13. 13.
    Palefsky JM, Holly EA, Ralston ML, et al. Anal squamous intraepithelial lesions in HIV-positive and HIV-negative homosexual and bisexual men: prevalence and risk factors. J Acquir Immune Defic Syndr Hum Retrovirol 1998;17:320–326.PubMedGoogle Scholar
  14. 14.
    Drobacheff C, Dupont P, Mougin C, et al. Anal human papillomavirus DNA screening by Hybrid Capture II in human immunodeficiency virus-positive patients with or without anal intercourse. Eur J Dermatol 2003;13:367–371.PubMedGoogle Scholar
  15. 15.
    Minkoff H, Ahdieh L, Massad LS, et al. The effect of highly active antiretroviral therapy on cervical cytologic changes associated with oncogenic HPV among HIV-infected women. Aids 2001;15:2157–2164.PubMedGoogle Scholar
  16. 16.
    Heard I, Schmitz V, Costagliola D, et al. Early regression of cervical lesions in HIV-seropositive women receiving highly active antiretroviral therapy. Aids 1998;12:1459–1464.PubMedGoogle Scholar
  17. 17.
    Lillo FB, Ferrari D, Veglia F, et al. Human papillomavirus infection and associated cervical disease in human immunodeficiency virus-infected women: effect of highly active antiretroviral therapy. J Infect Dis 2001;184:547–551.PubMedGoogle Scholar
  18. 18.
    Schuman P, Ohmit SE, Klein RS, et al. Longitudinal study of cervical squamous intraepithelial lesions in human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women. J Infect Dis 2003;188:128–136.PubMedGoogle Scholar
  19. 19.
    Nigro ND, Seydel HG, Considine B, et al. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal canal. Cancer 1983;51:1826–1829.PubMedGoogle Scholar
  20. 20.
    Beahrs O. Janeway Lecture. Management of cancer of the anus. AJR Am J Roentgenol 1979;133:790–795.PubMedGoogle Scholar
  21. 21.
    Boman BM, Moertel CG, O’Connell MJ, et al. Carcinoma of the anal canal. A clinical and pathologic study of 188 cases. Cancer 1984;54:114–125.PubMedGoogle Scholar
  22. 22.
    Leichman L, Nigro N, Vaitkevicius VK, et al. Cancer of the anal canal. Model for preoperative adjuvant combined modality therapy. Am J Med 1985;78:211–215.PubMedGoogle Scholar
  23. 23.
    Cummings B, Keane T, Thomas G, et al. Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy. Cancer 1984;54:2062–2068.PubMedGoogle Scholar
  24. 24.
    Meeker WR, Jr., Sickle-Santanello BJ, Philpott G, et al. Combined chemotherapy, radiation, and surgery for epithelial cancer of the anal canal. Cancer 1986;57:525–529.PubMedGoogle Scholar
  25. 25.
    Flam MS, John M, Lovalvo LJ, et al. Definitive nonsurgical therapy of epithelial malignancies of the anal canal. A report of 12 cases. Cancer 1983;51:1378–1387.PubMedGoogle Scholar
  26. 26.
    Michaelson RA, Magill GB, Quan SH, et al. Preoperative chemotherapy and radiation therapy in the management of anal epidermoid carcinoma. Cancer 1983;51:390–395.PubMedGoogle Scholar
  27. 27.
    Sischy B, Doggett RL, Krall JM, et al. Definitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on Radiation Therapy Oncology Group study no. 8314. J Natl Cancer Inst 1989;81:850–856.PubMedGoogle Scholar
  28. 28.
    Tveit KM, Karlsen KO, Fossa SD, et al. Primary treatment of carcinoma of the anus by combined radiotherapy and chemotherapy. Scand J Gastroenterol 1989;24:1243–1247.PubMedGoogle Scholar
  29. 29.
    Cummings BJ, Keane TJ, O’Sullivan B, et al. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys 1991;21:1115–1125.PubMedGoogle Scholar
  30. 30.
    Eschwege F, Lasser P, Chavy A, et al. Squamous cell carcinoma of the anal canal: treatment by external beam irradiation. Radiother Oncol 1985;3:145–150.PubMedGoogle Scholar
  31. 31.
    Dobrowsky W. Radiotherapy of epidermoid anal canal cancer. Br J Radiol 1989;62:53–58.PubMedGoogle Scholar
  32. 32.
    Doggett SW, Green JP, Cantril ST. Efficacy of radiation therapy alone for limited squamous cell carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 1988;15:1069–1072.PubMedGoogle Scholar
  33. 33.
    Martenson JA Jr, Gunderson LL. External radiation therapy without chemotherapy in the management of anal cancer. Cancer 1993;71:1736–1740.PubMedGoogle Scholar
  34. 34.
    Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 1996;14:2527–2539.PubMedGoogle Scholar
  35. 35.
    Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 1996;348:1049–1054.Google Scholar
  36. 36.
    Martenson JA, Lipsitz SR, Wagner H Jr, et al. Initial results of a phase II trial of high dose radiation therapy, 5-fluorouracil, and cisplatin for patients with anal cancer (E4229): an Eastern Cooperative Oncology Group study. Int J Radiat Oncol Biol Phys 1996;35:745–749.PubMedGoogle Scholar
  37. 37.
    Cho DS, Shieh G, Kuber N, et al. Definitive radiotherapy in the combined modality treatment of HIV anal carcinoma. Proceedings of the 20th American Society of Clinical Oncology, 2001 [Abstr 2350].Google Scholar
  38. 38.
    Hoecht S. Cancer of the anal canal and HIV-infection: toxicity and results of radiochemotherapy or radiotherapy. Proceedings of the 19th American Society of Clinical Oncology, 2000 [Abstr 1848].Google Scholar
  39. 39.
    Allen-Mersh T, Goldstone S, Sparano A, Elrafei T, Bower M. Is chemoradiation the treatment of choice for anal squamous cell carcinoma developing in HIV-positive patients with access to highly active antiretroviral therapy? Procceding of the 2004 Gastrointestinal Cancers Symposium: Current Status and Future Directions for SPrevention and Management, [Abstr 233]; p. 156.Google Scholar
  40. 40.
    Cote TR, Biggar RJ, Rosenberg PS, et al. Non-Hodgkin’s lymphoma among people with AIDS: incidence, presentation and public health burden. AIDS/Cancer Study Group. Int J Cancer 1997;73:645–650.PubMedGoogle Scholar
  41. 41.
    Biggar RJ, Rosenberg PS, Cote T. Kaposi’s sarcoma and non-Hodgkin’s lymphoma following the diagnosis of AIDS. Multistate AIDS/Cancer Match Study Group. Int J Cancer 1996;68:754–758.PubMedGoogle Scholar
  42. 42.
    Levine AM, Seneviratne L, Tulpule A. Incidence and management of AIDS-related lymphoma. Oncology (Huntingt) 2001;15:629–639.Google Scholar
  43. 43.
    Eltom MA, Jemal A, Mbulaiteye SM, et al. Trends in Kaposi’s sarcoma and non-Hodgkin’s lymphoma incidence in the United States from 1973 through 1998. J Natl Cancer Inst 2002;94:1204–1210.PubMedGoogle Scholar
  44. 44.
    Levine AM. Acquired immunodeficiency syndrome-related lymphoma. Blood 1992;80:8–20.PubMedGoogle Scholar
  45. 45.
    Levine AM, Gill PS, Meyer PR, et al. Retrovirus and malignant lymphoma in homosexual men. JAMA 1985;254:1921–1925.PubMedGoogle Scholar
  46. 46.
    Danzig JB, Brandt LJ, Reinus JF, Klein RS. Gastrointestinal malignancy in patients with AIDS. Am J Gastroenterol 1991;86:715–718.PubMedGoogle Scholar
  47. 47.
    Ullrich R, Zeitz M, Riecken EO. Enteric immunologic abnormalities in human immunodeficiency virus infection. Semin Liver Dis 1992;12:167–174.PubMedGoogle Scholar
  48. 48.
    Pluda JM, Venzon DJ, Tosato G, et al. Parameters affecting the development of non-Hodgkin’s lymphoma in patients with severe human immunodeficiency virus infection receiving antiretroviral therapy. J Clin Oncol 1993;11:1099–1107.PubMedGoogle Scholar
  49. 49.
    Shibata D, Weiss LM, Hernandez AM, et al. Epstein-Barr virus-associated non-Hodgkin’s lymphoma in patients infected with the human immunodeficiency virus. Blood 1993;81:2102–2109.PubMedGoogle Scholar
  50. 50.
    Levine AM, Said JW. Management of acquired immunodeficiency syndrome-related lymphoma, in Non-Hodgkins Lymphoma. Mauch P, ed. Lippincott, Williams and Wilkins, Philadelphia, PA, 2004; pp. 613–627.Google Scholar
  51. 51.
    Hernandez JA, Navarro JT, Ribera JM, et al. Primary gastrointestinal lymphoma in patients infected with HIV: study of 15 cases in a series of 76 patients with non-Hodgkin’s lymphoma and HIV infection. Med Clin (Barc) 1999;112:222–224.Google Scholar
  52. 52.
    Heise W, Arasteh K, Mostertz P, et al. Malignant gastrointestinal lymphomas in patients with AIDS. Digestion 1997;58:218–224.PubMedGoogle Scholar
  53. 53.
    Crump M, Gospodarowicz M, Shepherd FA. Lymphoma of the gastrointestinal tract. Semin Oncol 1999;26:324–337.PubMedGoogle Scholar
  54. 54.
    AliMohamed F, Lule GN, Nyong’o A, et al. Prevalence of Helicobacter pylori and endoscopic findings in HIV seropositive patients with upper gastrointestinal tract symptoms at Kenyatta National Hospital, Nairobi. East Afr Med J 2002;79:226–231.PubMedGoogle Scholar
  55. 55.
    Eidt S, Schrappe M, Fischer R. Analysis of antral biopsy specimens for evidence of acquired mucosa-associated lymphoid tissue in HIV1-seropositive and HIV1-negative patients. Scand J Gastroenterol 1995;30:635–639.PubMedGoogle Scholar
  56. 56.
    Wotherspoon AC, Diss TC, Pan L, et al. Low grade gastric B-cell lymphoma of mucosa associated lymphoid tissue in immunocompromised patients. Histopathology 1996;28:129–134.PubMedGoogle Scholar
  57. 57.
    Tokunaga O, Watanabe T, Shimamoto Y, Tokudome S. Primary T-cell lymphoma of the gastrointestinal tract associated with human T-cell lymphotropic virus type I. An analysis using in situ hybridization and polymerase chain reaction. Cancer 1993;71:708–716.PubMedGoogle Scholar
  58. 58.
    Ioachim HL, Antonescu C, Giancotti F, Dorsett B, Weinstein MA. EBV-associated anorectal lymphomas in patients with acquired immune deficiency syndrome. Am J Surg Pathol 1997;21:997–1006.PubMedGoogle Scholar
  59. 59.
    Imrie KR, Sawka CA, Kutas G, et al. HIV-associated lymphoma of the gastrointestinal tract: the University of Toronto AIDS-Lymphoma Study Group experience. Leuk Lymphoma 1995;16:343–349.PubMedGoogle Scholar
  60. 60.
    Cappell MS, Botros N. Predominantly gastrointestinal symptoms and signs in 11 consecutive AIDS patients with gastrointestinal lymphoma: a multicenter, multiyear study including 763 HIV-seropositive patients. Am J Gastroenterol 1994;89:545–549.PubMedGoogle Scholar
  61. 61.
    de Carvalho MG, Rodrigues MA, Marques ME, et al. Lesions of the gastrointestinal tract in acquired immunodeficiency syndrome: study of 45 consecutive necropsies. Rev Soc Bras Med Trop 1994;27:135–141.PubMedGoogle Scholar
  62. 62.
    Rich JD, Crawford JM, Kazanjian SN, et al. Discrete gastrointestinal mass lesions caused by cytomegalovirus in patients with AIDS: report of three cases and review. Clin Infect Dis 1992;15:609–614.PubMedGoogle Scholar
  63. 63.
    Yeguez JF, Martinez SA, Sands DR, et al. Colorectal malignancies in HIV-positive patients. Am Surg 2003;69:981–987.PubMedGoogle Scholar
  64. 64.
    Wallace MB, Thomas CR. Gastrointestinal lymphoma and AIDS-related gastrointestinal cancers, in Gastrointestinal Cancers: A Companion to Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Riustgi AK, ed. W.B. Saunders, Philadelphia, PA, 2003.Google Scholar
  65. 65.
    Levine AM, Wernz JC, Kaplan L, et al. Low-dose chemotherapy with central nervous system prophylaxis and zidovudine maintenance in AIDS-related lymphoma. A prospective multi-institutional trial. JAMA 1991;266:84–88.PubMedGoogle Scholar
  66. 66.
    Carucci LR, Halvorsen RA. Abdominal and pelvic CT in the HIV-positive population. Abdom Imaging 2004;29:631–642.PubMedGoogle Scholar
  67. 67.
    Radin DR, Esplin JA, Levine AM, et al. AIDS-related non-Hodgkin’s lymphoma: abdominal CT findings in 112 patients. Am J Roentgenol 1993;160:1133–1139Google Scholar
  68. 68.
    Herts BR, Megibow AJ, Birnbaum BA, et al. High-attenuation lymphadenopathy in AIDS patients: significance of findings at CT. Radiology 1992;185:777–781.PubMedGoogle Scholar
  69. 69.
    Kaplan LD, Abrams DI, Feigal E, et al. AIDS-associated non-Hodgkin’s lymphoma in San Francisco. JAMA 1989;261:719–724PubMedGoogle Scholar
  70. 70.
    Tirelli U, Errante D, Spina M, et al. Long-term survival of patients with HIV-related systemic non-Hodgkin’s lymphomas. Hematol Oncol 1996;14:7–15.PubMedGoogle Scholar
  71. 71.
    Levine AM, Sullivan-Halley J, Pike MC, et al. Human immunodeficiency virus-related lymphoma. Prognostic factors predictive of survival. Cancer 1991;68:2466–2472.PubMedGoogle Scholar
  72. 72.
    Straus DJ, Huang J, Testa MA, Levine AM, et al. Prognostic factors in the treatment of human immunodeficiency virus-associated non-Hodgkin’s lymphoma: analysis of AIDS Clinical Trials Group protocol 142—low-dose versus standard-dose m-BACOD plus granulocyte-macrophage colony-stimulating factor. National Institute of Allergy and Infectious Diseases. J Clin Oncol 1998;16:3601–3606.PubMedGoogle Scholar
  73. 73.
    Vaccher E, Tirelli U, Spina M, et al. Age and serum lactate dehydrogenase level are independent prognostic factors in human immunodeficiency virus-related non-Hodgkin’s lymphomas: a single-institute study of 96 patients. J Clin Oncol 1996;14:2217–2223.PubMedGoogle Scholar
  74. 74.
    Vaccher E, Spina M, Talamini R, et al. Improvement of systemic human immunodeficiency virus-related non-Hodgkins lymphoma outcome in the era of highly active antiretroviral therapy. Clin Infect Dis 2003;37:1556–1564.PubMedGoogle Scholar
  75. 75.
    Besson C, Goubar A, Gabarre J, et al. Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy. Blood. 2001;98:2339–2344.PubMedGoogle Scholar
  76. 76.
    Deziel DJ, Hyser MJ, Doolas A, et al. Major abdominal operations in acquired immunodeficiency syndrome. Am Surg 1990;56:445–450.PubMedGoogle Scholar
  77. 77.
    Wilson SE, Robinson G, Williams RA, et al. Acquired immune deficiency syndrome (AIDS). Indications for abdominal surgery, pathology, and outcome. Ann Surg 1989;210:428–433.PubMedGoogle Scholar
  78. 78.
    Ratner L, Lee J, Tang S, et al. Chemotherapy for human immunodeficiency virus-associated non-Hodgkin’s lymphoma in combination with highly active antiretroviral therapy. J Clin Oncol 2001;19:2171–2178.PubMedGoogle Scholar
  79. 79.
    Gill PS, Levine AM, Krailo M et al. AIDS-related malignant lymphoma: results of prospective treatment trials. J Clin Oncol 1987;5:1322–1328.PubMedGoogle Scholar
  80. 80.
    Kaplan LD, Straus DJ, Testa MA, et al. Low-dose compared with standard-dose m-BACOD chemotherapy for non-Hodgkin’s lymphoma associated with human immunodeficiency virus infection. National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group. N Engl J Med 1997;336:1641–1648.PubMedGoogle Scholar
  81. 81.
    Little RF, Pittaluga S, Grant N, et al. Highly effective treatment of acquired immunodeficiency syndrome-related lymphoma with dose-adjusted EPOCH: impact of antiretroviral therapy suspension and tumor biology. Blood 2003;101:4653–4659.PubMedGoogle Scholar
  82. 82.
    Levine AM, Tulpule A, Espina B, et al. Liposome-encapsulated doxorubicin in combination with standard agents (cyclophosphamide, vincristine, prednisone) in patients with newly diagnosed AIDS-related non-Hodgkin’s lymphoma: results of therapy and correlates of response. J Clin Oncol 2004;22:2662–2670.PubMedGoogle Scholar
  83. 83.
    Spina M, Jaeger U, Sparano JA, et al. Rituximab plus infusional cyclophosphamide, doxorubicin and etoposide (R-CDE) in HIV-associated non-Hodgkin’s lymphoma: pooled results from three phase II trials. Blood 2005;105:1891–1897.PubMedGoogle Scholar
  84. 84.
    Friedman SL. Gastrointestinal and hepatobiliary neoplasms in AIDS. Gastroent Clin N Am 1988;17:465–487.Google Scholar
  85. 85.
    Hanno R, Owen LG, Callen JP. Kaposi’s sarcoma with extensive internal involvement. Int J Dermatol 1979;18:719–721.Google Scholar
  86. 86.
    Templeton AC. Studies in Kaposi’s sarcoma, post mortem findings and disease patterns in women. Cancer 1972;30:854–867.PubMedGoogle Scholar
  87. 87.
    Hiesse C, Kriaa F, Riev P, et al. Incidence and type of malignancies occurring after renal transplantation in conventionally and cyclosporine-treated recipients: analysis of a 20-year period in 1600 patients. Transplant Proc 1995;27:972–974.PubMedGoogle Scholar
  88. 88.
    Shepherd FA, Maher E, Cardella C, et al. Treatment of Kaposi’s sarcoma after solid organ transplantation. J Clin Oncol 1997;15:2371–2377.PubMedGoogle Scholar
  89. 89.
    Freidman-Kien AE, Laubenstein L, Marmor M, et al. Kaposi’s sarcoma and Pneumocystis pneumonia among homosexual men—New York City and California. MMWR 1981;30:305–308.Google Scholar
  90. 90.
    Report of the CDC Task Force on Kaposi’s sarcoma and opportunistic infections: Epidemiologic aspects of the current outbreak of Kaposi’s sarcoma and opportunistic infections. N Engl J Med 1982;306:248–252.Google Scholar
  91. 91.
    Cannon M, Cesarman E. Kaposi’s sarcoma-associated herpes virus and acquired immunodeficiency syndrome-related malignancy. Semin Oncol 2000;27:409–419.PubMedGoogle Scholar
  92. 92.
    Biggar RJ, Rabkin CS. The epidemiology of AIDS-related neoplasms. Hem Onc Clin N Am 1996;10:997–1010.Google Scholar
  93. 93.
    Chang Y, Cesarman E, Pessin MS, et al. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi’s sarcoma. Science 1994;266:1865–1869.PubMedGoogle Scholar
  94. 94.
    Cannon M, Dollard SC, Black JB, et al. Risk factors for Kaposi’s sarcoma in men seropositive for both HHV8 and HIV. Aids 2003;17:215–222.PubMedGoogle Scholar
  95. 95.
    Martin JN, Ganem DE, Osmond DH, et al. Sexual transmission and the natural history of human herpes virus 8 infection. N Engl J Med 1998;338:948–954.PubMedGoogle Scholar
  96. 96.
    Antman K, Chang Y. Kaposi’s sarcoma. N Engl J Med 2000;342:1027–1038.PubMedGoogle Scholar
  97. 97.
    Kaaya EE, Parravicini C, Ordonez C, et al: Heterogeneity of spindle cells in Kaposi’s sarcoma; comparison of cells in lesions and in culture. J Acquir Immun Defic Synd Hum Retrovirol 1995;10:295–305.Google Scholar
  98. 98.
    Gill PS, Tsai YC, Rao AP, et al. Evidence for multiclonality in multicentric Kaposi’s sarcoma. Proc Natl Acad Sci USA 1998;95:8257–8261.PubMedGoogle Scholar
  99. 99.
    Ensoli B, Nakamura S, Salahuddin SZ, et al. AIDS-Kaposi’s sarcoma-derived cells express cytokines with autocrine and paracrine growth effects. Science 1989;243:223–226.PubMedGoogle Scholar
  100. 100.
    Reichert CM, O’Leary TJ, Levens DL, et al. Autopsy pathology in the acquired immune deficiency syndrome. Am J Path 1983;112:357–382.PubMedGoogle Scholar
  101. 101.
    Umerah BC, Kaposi’s sarcoma of the oesophagus. Br J Radiol 1980;53:807–808.PubMedGoogle Scholar
  102. 102.
    Reed WB, Kamath HM, Weiss L. Kaposi’s sarcoma, with emphasis on the internal manifestations. Arch Dermatol 1974;110:115–118.PubMedGoogle Scholar
  103. 103.
    Krigel RL, Laubenstein LJ, Muggia FM. Kaposi’s sarcoma: a new staging classification. Cancer Treat Report 1983;67:531–534.Google Scholar
  104. 104.
    Rose HS, Balthazar EJ, Megibow AJ, et al. Alimentary tract involvement in Kaposi’s sarcoma: radiographic and endoscopic findings in 25 homosexual men. Am J Roentgenol 1982;139:661–666.Google Scholar
  105. 105.
    Ioachim HL, Adsay V, Giancotti FR, et al. Kaposi’s sarcoma of the internal organs, a multiparameter study of 86 cases. Cancer 1995;75:1376–1385.PubMedGoogle Scholar
  106. 106.
    Freidman SL, Wright TL, Altman DF. Gastrointestinal Kaposi’s sarcoma in patients with acquired immunodeficiency syndrome, endoscopic and autopsy findings. Gastroent 1985;89:102–108.Google Scholar
  107. 107.
    Saltz RK, Kurtz RC, Lightdale CJ, et al. Kaposi’s sarcoma, gastrointestinal involvement correlation with skin findings and immunologic function. Digest Dis Sci 1984;29:817–823.PubMedGoogle Scholar
  108. 108.
    Rodgers VD, Kagnoff MF. Gastrointestinal manifestations of the acquired immunodeficiency syndrome. West J Med 1987;146:57–67.PubMedGoogle Scholar
  109. 109.
    Windle-Taylor PC, Shah N. Oropharyngeal Kaposi’s sarcoma. Report of two cases and review of the literature. J Laryn Otol 1983;97:1665–1671.Google Scholar
  110. 110.
    Lozada F, Silverman S, Migliorati A, et al. Oral manifestations of tumor and opportunistic infections in the acquired immunodeficiency syndrome (AIDS): findings in 53 homosexual men with Kaposi’s sarcoma. Oral Surg 1983;56:491–493.PubMedGoogle Scholar
  111. 111.
    Perrone V, Pergola M, Abate G, et al. Protein-losing enteropathy in a patient with generalized Kaposi’s sarcoma. Cancer 1981;47:588–591.PubMedGoogle Scholar
  112. 112.
    Sharpstone D, Rowbottom A, Nelson M, et al. Faecal alpha-1 antitrypsin as a marker of gastrointestinal disease in HIV antibody positive individuals. Gut 1996;38:206–210.PubMedGoogle Scholar
  113. 113.
    Wall SD, Freidman SL, Margolis AR. Gastrointestinal Kaposi’s sarcoma in AIDS: radiographic manifestations. J Clin Gastroent 1984;6:165–171.PubMedCrossRefGoogle Scholar
  114. 114.
    Port JH, Traube J, Winans CS. The visceral manifestations of Kaposi’s sarcoma. Gastrointest Endoscop 1982;28:179–181.CrossRefGoogle Scholar
  115. 115.
    Lebbe C, Blum L, Pellet C, et al. Clinical and biological impact of antiretroviral therapy with protease inhibitors on HIV-related Kaposi’s sarcoma. AIDS 1998;12:F45-F49.PubMedGoogle Scholar
  116. 116.
    Sgadari C, Monini P, Barillari G, Ensoli B. Use of HIV protease inhibitors to block Kaposi’s sarcoma and tumour growth. Lancet Oncol 2003;4:537–547.PubMedGoogle Scholar
  117. 117.
    Gill PS, Loureiro C, Bernstein-Singer M, et al. Clinical Effect of glucocorticoids on Kaposi’s sarcoma related to the acquired immunodeficiency syndrome (AIDS). Ann Int Med 1989;110:937–940.PubMedGoogle Scholar
  118. 118.
    Nichols CM, Flaitz CM, Hicks MJ. Treating Kaposi’s lesions in the HIV-infected patient. J Am Dert Assoc 1993;124:78–84.Google Scholar
  119. 119.
    Kaufmann T, Nisce LZ, Coleman M. Case report: Kaposi’s sarcoma of the rectum — treatment with radiation therapy. Br J Radiol 1996;69:573–574.PubMedCrossRefGoogle Scholar
  120. 120.
    Dezube BJ. Acquired immunodeficiency syndrome-related Kaposi’s sarcoma: clinical features, staging, and treatment. Semin Oncol 2000;27:424–430.PubMedGoogle Scholar
  121. 121.
    Northfelt DW, Dezube BJ, Thommes JA, et al. Pegylatedliposomal doxorubicin versus doxorubicin, bleomycin, and vincristine in the treatment of AIDS-related Kaposi’s sarcoma: results of a randomized phase III clinical trial. J Clin Oncol 1998;16:2445–2451.PubMedGoogle Scholar
  122. 122.
    Welles L, Saville MW, Lietzau J, et al. Phase II trial with dose titration of paclitaxel for the therapy of human immunodeficiency virus-associated Kaposi’s sarcoma. J Clin Oncol 1998;16:1112–1121.PubMedGoogle Scholar
  123. 123.
    Martin DF, Kuppermann BD, Wolitz RA. Oral ganciclovir for patients with cytomegalovirus retinitis treated with a ganciclovir implant. N Engl J Med 1999;340:1063–1070.PubMedGoogle Scholar

Copyright information

© Humana Press Inc 2005

Authors and Affiliations

  • Mary Koshy
    • 1
  • John Kauh
    • 2
  • Clifford Gunthel
    • 2
  • Melissa Joyner
    • 3
  • Jerome Landry
    • 1
  • Charles R. ThomasJr.
    • 3
    Email author
  1. 1.Department of Radiation OncologyEmory University School of MedicineAtlanta
  2. 2.Department of Medical Oncology, Department of Radiation OncologyEmory University School of MedicineAtlanta
  3. 3.Department of Radiation OncologyUniversity of Texas Health Science CenterSan Antonio

Personalised recommendations