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Kaposi Sarcoma Treatment (PDQ®)–Health Professional Version
General Information About Kaposi Sarcoma
KS was first described in 1872 by the Hungarian dermatologist, Moritz Kaposi. From that time until the current human immunodeficiency virus (HIV) disease epidemic identified with the Acquired Immunodeficiency Syndrome (AIDS), KS remained a rare tumor. While most of the cases seen in Europe and North America have occurred in elderly men of Italian or Eastern European Jewish ancestry, the neoplasm also occurs in several other distinct populations: young black African adult males, prepubescent children, renal allograft recipients, and other patients receiving immunosuppressive therapy. The disseminated, fulminant form of KS associated with HIV disease is referred to as epidemic KS to distinguish it from the classic, African, and transplant-related varieties of the neoplasm. In addition, KS has been identified in homosexual men apart from the HIV disease epidemic.[ 1]
Although the histopathology of the different types of the Kaposi tumor is essentially identical in all of these groups, the clinical manifestations and course of the disease differ dramatically.[ 2] A key piece to the puzzle of KS pathogenesis was the 1994 discovery of a gamma herpes virus, human herpes virus type 8 (HHV-8), also known as Kaposi sarcoma herpes virus.[ 3] HHV-8 was identified in KS tissue biopsies from virtually all patients with classic, African, transplant-related, and AIDS-associated KS but was absent from noninvolved tissue.[ 4-7]
Classic Kaposi Sarcoma
Considered a rare disease, classic KS occurs more often in males, with a ratio of approximately 10 to 15 males to 1 female. In North Americans and Europeans, the usual age at onset is between 50 and 70 years. Classic KS tumors usually present with one or more asymptomatic red, purple, or brown patches, plaques, or nodular skin lesions. The disease is often limited to single or multiple lesions usually localized to one or both lower extremities, especially involving the ankles and soles.
Classic KS most commonly runs a relatively benign, indolent course for 10 to 15 years or more, with slow enlargement of the original tumors and the gradual development of additional lesions. Venous stasis and lymphedema of the involved lower extremity are frequent complications. In long-standing cases, systemic lesions can develop along the gastrointestinal tract, in lymph nodes, and in other organs. The visceral lesions are generally asymptomatic and are most often discovered only at autopsy, though clinically, gastrointestinal bleeding can occur. As many as 33% of the patients with classic KS develop a second primary malignancy, which is most often non-Hodgkin lymphoma.[ 8-10]
African Kaposi Sarcoma
In the 1950s, KS was recognized as a relatively common neoplasm endemic in native populations in equatorial Africa and comprised approximately 9% of all cancers seen in Ugandan males. African KS is seen as either an indolent neoplasm identical to the classic disease seen in Europe and North America or as an aggressive disease with fungating and exophytic tumors that may invade the subcutaneous and surrounding tissue including the underlying bone. In Africa, both the indolent and locally more aggressive forms of KS occur with a male-to-female ratio comparable to that observed with the classic KS tumor seen in North America and Europe. In general, however, patients in Africa are significantly younger than their European counterparts. A lymphadenopathic form of KS is also seen in Africa, primarily in prepubescent children (male:female ratio, 3:1). In these cases, the generalized lymphadenopathy is frequently associated with visceral organ involvement. The prognosis is very poor with a 100% fatality rate within 3 years.[ 11,12]
Immunosuppressive Treatment–Related Kaposi Sarcoma
In 1969, the first case of KS in association with immunosuppression in a renal transplant patient was described. Since that time, a number of renal and other organ allograft recipients who received prednisone and azathioprine developed KS shortly after the onset of immunosuppressive therapy.[ 13] Estimates of the incidence of KS in immunosuppressed renal transplant recipients are between 150 and 200 times the expected incidence of the tumor in the general population. The average time to develop KS after transplantation is 16 months. Although the KS tumor in iatrogenically immunosuppressed patients often remains localized to the skin, widespread dissemination with mucocutaneous or visceral organ involvement is common. In some cases, the KS tumors have regressed as a result of reduction or changes in immunosuppressive therapy. Clinical management of renal transplant patients who develop KS is difficult and requires a balance between the risk of death from generalized KS and the risk of graft rejection and complications of renal failure that may occur if the immunosuppressive therapy is discontinued.
Epidemic Kaposi Sarcoma
In 1981, a fulminant and disseminated form of KS in young homosexual or bisexual men was first reported as part of an epidemic now known as AIDS.[ 14] The etiology of AIDS is a T-cell lymphotropic retrovirus known as HIV. The underlying immunologic deficiency that characterizes HIV disease is an acquired profound disorder of cell-mediated immune functions. This immunologic deficiency and immune dysregulation predisposes the host to a variety of opportunistic infections and unusual neoplasms, especially KS. HIV may play an indirect role in the development of KS.[ 15]
Approximately 95% of all the cases of epidemic KS in the United States have been diagnosed in homosexual or bisexual men. In the past, approximately 26% of all homosexual males with HIV disease presented with, or eventually developed, KS during the course of their illness. By comparison, fewer than 3% of all heterosexual intravenous drug users with HIV disease developed KS. The proportion of HIV disease patients with KS has steadily decreased since the epidemic was first identified in 1981.[ 16] About 48% of AIDS patients in 1981 had KS as their presenting AIDS diagnosis. By August 1987, the cumulative proportion of AIDS patients with KS had diminished to fewer than 20%. The introduction of combined antiretroviral therapy (cART) has delayed or prevented the emergence of drug-resistant HIV strains, profoundly decreased viral load, led to increased survival, and lessened the risk of opportunistic infections.[ 17-19] The use of cART has been associated with a sustained and substantial decline in KS incidence in multiple large cohorts.[ 20-25]
The lesions that develop may involve the skin; oral mucosa; lymph nodes; and visceral organs, such as the gastrointestinal tract, lung, liver, and spleen. Most patients with HIV disease who present with the mucocutaneous lesions of KS feel healthy and are usually free of systemic symptoms, as compared with HIV patients who first develop an opportunistic infection. The sites of disease at presentation of epidemic KS are much more varied than the sites seen in other types of this neoplasm. In an early report on the clinical manifestations of the disease, 49 patients were described.[ 26] Of these patients, 8% had no skin involvement, 27% had localized or fewer than five skin lesions, and 63% had innumerable skin lesions widely distributed over the skin surface area. Of these patients, 61% had generalized lymphadenopathy at the time of the first examination. Four of these patients, who had generalized lymphadenopathy in the absence of skin lesions or detectable visceral organ involvement at the time of presentation, were found to have biopsy-proven KS localized to the lymph nodes. In 45% of the patients studied, KS lesions were found in one or more sites along the gastrointestinal tract. Of these patients, 29% had either unexplained fever or unexplained weight loss when first seen. While most patients present with skin disease, KS involvement of lymph nodes or the gastrointestinal tract may occasionally precede the appearance of the cutaneous lesions.
Eventually, most patients with epidemic KS develop disseminated disease. The disease often progresses in an orderly fashion from a few localized or widespread mucocutaneous lesions to more numerous lesions and generalized skin disease with lymph node, gastrointestinal tract disease, and other organ involvement. Pleuropulmonary KS is an ominous sign usually occurring late in the course of the disease, especially in those patients whose death is directly attributed to KS.[ 27] Most patients with epidemic KS die of one or more complicating opportunistic infections.
- Friedman-Kien AE, Saltzman BR, Cao YZ, et al.: Kaposi's sarcoma in HIV-negative homosexual men. Lancet 335 (8682): 168-9, 1990. [PUBMED Abstract]
- Safai B: Kaposi's sarcoma and acquired immunodeficiency syndrome. In: DeVita VT, Hellman S, Rosenberg S, eds.: AIDS: Etiology, Diagnosis, Treatment and Prevention. 4th ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1997, pp 295-318.
- Chang Y, Cesarman E, Pessin MS, et al.: Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma. Science 266 (5192): 1865-9, 1994. [PUBMED Abstract]
- Moore PS, Chang Y: Detection of herpesvirus-like DNA sequences in Kaposi's sarcoma in patients with and without HIV infection. N Engl J Med 332 (18): 1181-5, 1995. [PUBMED Abstract]
- Su IJ, Hsu YS, Chang YC, et al.: Herpesvirus-like DNA sequence in Kaposi's sarcoma from AIDS and non-AIDS patients in Taiwan. Lancet 345 (8951): 722-3, 1995. [PUBMED Abstract]
- Gao SJ, Kingsley L, Li M, et al.: KSHV antibodies among Americans, Italians and Ugandans with and without Kaposi's sarcoma. Nat Med 2 (8): 925-8, 1996. [PUBMED Abstract]
- Chang Y, Ziegler J, Wabinga H, et al.: Kaposi's sarcoma-associated herpesvirus and Kaposi's sarcoma in Africa. Uganda Kaposi's Sarcoma Study Group. Arch Intern Med 156 (2): 202-4, 1996. [PUBMED Abstract]
- Safai B, Good RA: Kaposi's sarcoma: a review and recent developments. Clin Bull 10 (2): 62-9, 1980. [PUBMED Abstract]
- Reynolds WA, Winkelmann RK, Soule EH: Kaposi's sarcoma: a clinicopathologic study with particular reference to its relationship to the reticuloendothelial system. Medicine (Baltimore) 44 (5): 419-43, 1965. [PUBMED Abstract]
- Safai B, Miké V, Giraldo G, et al.: Association of Kaposi's sarcoma with second primary malignancies: possible etiopathogenic implications. Cancer 45 (6): 1472-9, 1980. [PUBMED Abstract]
- Taylor JF, Templeton AC, Vogel CL, et al.: Kaposi's sarcoma in Uganda: a clinico-pathological study. Int J Cancer 8 (1): 122-35, 1971. [PUBMED Abstract]
- Templeton AC, Bhana D: Prognosis in Kaposi's sarcoma. J Natl Cancer Inst 55 (6): 1301-4, 1975. [PUBMED Abstract]
- Penn I: Kaposi's sarcoma in organ transplant recipients: report of 20 cases. Transplantation 27 (1): 8-11, 1979. [PUBMED Abstract]
- Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR Morb Mortal Wkly Rep 30 (25): 305-8, 1981. [PUBMED Abstract]
- Vogel J, Hinrichs SH, Reynolds RK, et al.: The HIV tat gene induces dermal lesions resembling Kaposi's sarcoma in transgenic mice. Nature 335 (6191): 606-11, 1988. [PUBMED Abstract]
- Selik RM, Starcher ET, Curran JW: Opportunistic diseases reported in AIDS patients: frequencies, associations, and trends. AIDS 1 (3): 175-82, 1987. [PUBMED Abstract]
- Flexner C: HIV-protease inhibitors. N Engl J Med 338 (18): 1281-92, 1998. [PUBMED Abstract]
- Palella FJ Jr, Delaney KM, Moorman AC, et al.: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 338 (13): 853-60, 1998. [PUBMED Abstract]
- Lodi S, Guiguet M, Costagliola D, et al.: Kaposi sarcoma incidence and survival among HIV-infected homosexual men after HIV seroconversion. J Natl Cancer Inst 102 (11): 784-92, 2010. [PUBMED Abstract]
- Portsmouth S, Stebbing J, Gill J, et al.: A comparison of regimens based on non-nucleoside reverse transcriptase inhibitors or protease inhibitors in preventing Kaposi's sarcoma. AIDS 17 (11): F17-22, 2003. [PUBMED Abstract]
- International Collaboration on HIV and Cancer: Highly active antiretroviral therapy and incidence of cancer in human immunodeficiency virus-infected adults. J Natl Cancer Inst 92 (22): 1823-30, 2000. [PUBMED Abstract]
- Dupont C, Vasseur E, Beauchet A, et al.: Long-term efficacy on Kaposi's sarcoma of highly active antiretroviral therapy in a cohort of HIV-positive patients. CISIH 92. Centre d'information et de soins de l'immunodéficience humaine. AIDS 14 (8): 987-93, 2000. [PUBMED Abstract]
- Tam HK, Zhang ZF, Jacobson LP, et al.: Effect of highly active antiretroviral therapy on survival among HIV-infected men with Kaposi sarcoma or non-Hodgkin lymphoma. Int J Cancer 98 (6): 916-22, 2002. [PUBMED Abstract]
- Carrieri MP, Pradier C, Piselli P, et al.: Reduced incidence of Kaposi's sarcoma and of systemic non-hodgkin's lymphoma in HIV-infected individuals treated with highly active antiretroviral therapy. Int J Cancer 103 (1): 142-4, 2003. [PUBMED Abstract]
- Grabar S, Abraham B, Mahamat A, et al.: Differential impact of combination antiretroviral therapy in preventing Kaposi's sarcoma with and without visceral involvement. J Clin Oncol 24 (21): 3408-14, 2006. [PUBMED Abstract]
- Krigel RL, Laubenstein LJ, Muggia FM: Kaposi's sarcoma: a new staging classification. Cancer Treat Rep 67 (6): 531-4, 1983. [PUBMED Abstract]
- Gill PS, Akil B, Colletti P, et al.: Pulmonary Kaposi's sarcoma: clinical findings and results of therapy. Am J Med 87 (1): 57-61, 1989. [PUBMED Abstract]
Stage Information for Kaposi Sarcoma
The staging evaluation of patients with classic Kaposi sarcoma (KS) should be individualized. The advanced age of most of the patients, localized nature of the tumor, rarity of visceral involvement, and usually indolent course of the disease should temper the extent of the evaluation. A careful examination of the skin and lymph nodes is sufficient in most cases. For the rare patient with rapidly progressive tumor or signs or symptoms of visceral involvement, appropriate evaluation is indicated. No universally accepted classification is available for epidemic KS. Staging schemes that incorporate laboratory parameters as well as clinical features have been proposed. Since most patients with epidemic KS do not die from the disease, factors besides tumor burden are apparently involved in survival.
The conventions used to stage KS and the methods used to evaluate the benefits of KS treatment continue to evolve because of changes in the treatment of human immunodeficiency virus (HIV) and in recognition of deficiencies in standard tumor assessment. The clinical course of KS, the selection of treatment, and the response to treatment are heavily influenced by the degree of underlying immune dysfunction and opportunistic infections.
The AIDS Clinical Trials Group (ACTG) Oncology Committee has published criteria for the evaluation of epidemic KS.[ 1] The staging system incorporates measures of extent of disease, severity of immunodeficiency, and presence of systemic symptoms. As shown in Table 1 below, the ACTG criteria categorizes the extent of the tumor as localized or disseminated, the CD4 cell number as high or low, and a systemic illness as absent or present.
A subsequent prospective analysis of 294 patients entered on ACTG trials for KS between 1989 and 1995 showed that each of the tumor, immune system, and systemic illness variables was independently associated with survival.[ 2] Multivariate analysis showed that immune system impairment was the most important single predictor of survival. In patients with relatively high CD4 counts, tumor stage was predictive. A CD4 count of 150 cells/mm³ may be a better discriminator than the published cutoff of 200 cells/mm³. A study is in progress to determine if viral load adds predictive information. None of the prior studies were conducted at a time when combined antiretroviral therapy (cART) was readily available. The impact of cART on survival in KS requires continued assessment.
|Good Risk (0)
|Poor Risk (1)
|(Any of the following)
|(Any of the following)
|Tumor (T)
|Confined to skin and/or lymph nodes and/or minimal oral disease[ Note: Minimal oral disease is non-nodular KS confined to the palate. ]
|Tumor-associated edema or ulceration
|Extensive oral KS
|Gastrointestinal KS
|KS in other non-nodal viscera
|Immune system (I)
|CD4 cells ≥ = 200/µL
|CD4 cells <200 per cubic mm
|Systemic illness (S)
|No history of OIs or thrush[ Note: OIs are opportunistic infections. ]
|History of OIs and/or thrush
|No "B" symptoms[ Note: "B" symptoms are unexplained fever, night sweats, >10% involuntary weight loss, or diarrhea persisting >2 weeks. ]
|"B" symptoms present
|Performance status ≥70 (Karnofsky)
|Performance status <70
|Other HIV-related illness (e.g., neurological disease or lymphoma)
- Krown SE, Metroka C, Wernz JC: Kaposi's sarcoma in the acquired immune deficiency syndrome: a proposal for uniform evaluation, response, and staging criteria. AIDS Clinical Trials Group Oncology Committee. J Clin Oncol 7 (9): 1201-7, 1989. [PUBMED Abstract]
- Krown SE, Testa MA, Huang J: AIDS-related Kaposi's sarcoma: prospective validation of the AIDS Clinical Trials Group staging classification. AIDS Clinical Trials Group Oncology Committee. J Clin Oncol 15 (9): 3085-92, 1997. [PUBMED Abstract]
Classic Kaposi Sarcoma Treatment
Classic Kaposi sarcoma (KS) usually is limited to the skin and has an indolent course. Patients with this tumor are predisposed to the development of a second primary malignancy, and the treating physician should consider this factor when arranging a schedule of follow-up treatment for the patient.
Equivalent standard treatment options:
Solitary lesions:
- Radiation therapy: For solitary lesions or lesions of limited extent, modest doses of radiation applied to the lesions with a limited margin provide excellent control of disease in the treated area. Usually, superficial radiation beams such as electron beams are used. Some authors believe disease recurrence in adjacent, untreated skin is common if only involved-field radiation therapy is used and claim better cure rates when extended-field radiation therapy is used.[ 1,2]
- Low-voltage (100 kv) photon radiation: 8 Gy to 10 Gy given as a single dose or 15 Gy to 20 Gy given over 1 week because solitary lesions control nearly 100% of local disease, but recurrence in adjacent areas is common.
- Electron-beam radiation therapy (EBRT): 4 Gy given once weekly for 6 to 8 consecutive weeks with a 4-MeV to 6-MeV electron beam. Ports should include the entire skin surface 15 cm above the lesion.
- Surgical excision may be of benefit in some patients with small superficial lesions, but local recurrence is likely to be a problem. However, over the years, multiple small excisions can be performed to achieve good disease control.
Widespread skin disease:
- Radiation therapy: Modest doses are effective in controlling disease. The type of radiation (i.e., photon vs. electron) and fields used must be tailored to suit the distribution of disease in the individual patient.[ 2]
- Extended-field EBRT.
- For disease limited to areas distal to the knee, subtotal-skin EBRT directed to skin below the umbilicus.
- For disease that extends above the knee, total-skin EBRT.
EBRT used in this manner gave long-term results that were superior to those obtained with radiation therapy administered to successive individual lesions as they appeared.[ 2]
- EBRT: 4 Gy given once weekly for 6 to 8 consecutive weeks, and subtotal- or total-skin radiation therapy given for extensive disease.
- Chemotherapy: Because classic KS is such a rare disease in the United States and is usually treated initially with radiation therapy, few patients have been treated with chemotherapy, and no randomized prospective trials have compared one agent to another. Several authors have used single-agent vinblastine given as a weekly dose of approximately 0.1 mg/kg.[ 3-6] Almost all of the patients had good to excellent response. In most cases, patients required prolonged courses of therapy, for several years, to maintain a partial response. Doses of vinblastine were titrated in individual patients to maintain a white blood count of more than 3,000 leukocytes. Follow-up after completion of therapy was not presented. In a multicenter trial of 55 patients who were treated over a decade, a 71% overall response rate was seen using pegylated liposomal doxorubicin.[ 7][Level of evidence: 3iiiDiv ] In addition to the positive response rates of pegylated liposomal doxorubicin and the vinca alkaloids, response rates showing a greater than 50% decrease in lesions have also been reported in small, uncontrolled series for etoposide, taxanes, gemcitabine, and interferon alfa.[ 8][Level of evidence: 3iiiDiv ]
One patient was treated repeatedly with intralesional injections of 0.25 to 0.50 mg of vincristine, which resulted in complete disappearance of the treated lesion.[ 9] Multiple courses of therapy were required because of the recurrence of disease in untreated areas.
Electroporation of the skin lesions was combined with intravenous bleomycin for 19 patients with classical KS. Most patients responded after one application, the rest after two or three applications, with a median duration of response of 16 months.[ 10][Level of evidence: 3iiiDiv ]
Lymph node and gastrointestinal tract involvement:
- Chemotherapy: Several patients who had widespread skin disease and were treated with chemotherapy also had lymph node and gastrointestinal tract involvement. The disease in these sites also responded to vinblastine. Trials are required to define therapy. One such trial, MSKCC-04055 (NCT00096538), has been completed.
- Local radiation therapy may be added to chemotherapy if individual lesions require urgent therapy.
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
- Hamilton CR, Cummings BJ, Harwood AR: Radiotherapy of Kaposi's sarcoma. Int J Radiat Oncol Biol Phys 12 (11): 1931-5, 1986. [PUBMED Abstract]
- Nisce LZ, Safai B, Poussin-Rosillo H: Once weekly total and subtotal skin electron beam therapy for Kaposi's sarcoma. Cancer 47 (4): 640-4, 1981. [PUBMED Abstract]
- Solan AJ, Greenwald ES, Silvay O: Long-term complete remissions of Kaposi's sarcoma with vinblastine therapy. Cancer 47 (4): 637-9, 1981. [PUBMED Abstract]
- Tucker SB, Winkelmann RK: Treatment of Kaposi sarcoma with vinblastine. Arch Dermatol 112 (7): 958-61, 1976. [PUBMED Abstract]
- Scott WP, Voight JA: Kaposi's sarcoma. Management with vincaleucoblastine. Cancer 19 (4): 557-64, 1966. [PUBMED Abstract]
- Klein E, Schwartz RA, Laor Y, et al.: Treatment of Kaposi's sarcoma with vinblastine. Cancer 45 (3): 427-31, 1980. [PUBMED Abstract]
- Di Lorenzo G, Kreuter A, Di Trolio R, et al.: Activity and safety of pegylated liposomal doxorubicin as first-line therapy in the treatment of non-visceral classic Kaposi's sarcoma: a multicenter study. J Invest Dermatol 128 (6): 1578-80, 2008. [PUBMED Abstract]
- Régnier-Rosencher E, Guillot B, Dupin N: Treatments for classic Kaposi sarcoma: a systematic review of the literature. J Am Acad Dermatol 68 (2): 313-31, 2013. [PUBMED Abstract]
- Odom RB, Goette DK: Treatment of cutaneous Kaposi's sarcoma with intralesional vincristine. Arch Dermatol 114 (11): 1693-4, 1978. [PUBMED Abstract]
- Di Monta G, Caracò C, Benedetto L, et al.: Electrochemotherapy as "new standard of care" treatment for cutaneous Kaposi's sarcoma. Eur J Surg Oncol 40 (1): 61-6, 2014. [PUBMED Abstract]
Immunosuppressive Therapy–Related Kaposi Sarcoma Treatment
Some patients with Kaposi Sarcoma (KS) have noted spontaneous and lasting remissions following discontinuation of immunosuppressive therapy. In managing these patients, if immunosuppressive therapy is not critical, its discontinuation is a reasonable first step.
Standard treatment options:
- Discontinue immunosuppressive therapy (often results in tumor regression). This option is critically important in patients who are receiving immunosuppressive drugs, as in the case of certain transplant patients.
- Radiation therapy (for disease limited to skin).[ 1-4]
- Chemotherapy (single or multiple drug): Most systemic chemotherapy trials in KS patients have been carried out in the African and epidemic varieties. See the section on the treatment of Epidemic Kaposi Sarcoma . The applicability of the results of these trials to KS in immunosuppressed patients is unknown.
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
- Cohen L: Dose, time, and volume parameters in irradiation therapy of Kaposi's sarcoma. Br J Radiol 35 (415): 485-488, 1962.
- Hamilton CR, Cummings BJ, Harwood AR: Radiotherapy of Kaposi's sarcoma. Int J Radiat Oncol Biol Phys 12 (11): 1931-5, 1986. [PUBMED Abstract]
- Lo TC, Salzman FA, Smedal MI, et al.: Radiotherapy for Kaposi's sarcoma. Cancer 45 (4): 684-7, 1980. [PUBMED Abstract]
- Nisce LZ, Safai B, Poussin-Rosillo H: Once weekly total and subtotal skin electron beam therapy for Kaposi's sarcoma. Cancer 47 (4): 640-4, 1981. [PUBMED Abstract]
Epidemic Kaposi Sarcoma Treatment
Treatment may result:
- In a disappearance or reduction in size of specific skin lesions, thereby alleviating the discomfort associated with the chronic edema and ulcerations that often accompany multiple skin tumors seen on the lower extremities.
- In control of symptoms associated with mucosal or visceral lesions.
No data are available, however, to show that treatment improves survival.[ 1] In addition to antitumor treatment, essential components of an optimal Kaposi sarcoma (KS) treatment strategy include combined antiretroviral treatment (cART), prophylaxis for opportunistic infections, and rapid recognition and treatment of intercurrent infections.
Most good-risk patients, defined by the AIDS Clinical Trials Group as T0, show tumor regression with cART alone.[ 2-4] Poor-risk patients, defined as T1, usually require a combination of cART and chemotherapy with discontinuation of the chemotherapy after disappearance of the skin lesion.[ 2-4] The combination of cART and liposomal doxorubicin resulted in a 5-year overall survival (OS) rate of 85% in 140 patients with T1 disease.[ 3][Level of evidence: 3iiiDiv ]
Local modalities
Small localized lesions of KS may be treated by electrodesiccation and curettage, cryotherapy, or by surgical excision. KS tumors are also generally very responsive to local radiation therapy, and excellent palliation has been obtained with doses at 20 Gy or slightly higher.[ 5-7] One report demonstrated a response rate higher than 90%, with a median time to progression of 21 months. Although no difference in response was noted with a variety of fractionation regimens, a single fraction of 8 Gy is indicated for cutaneous lesions and is associated with significantly fewer severe reactions.[ 8] Radiation therapy is generally reserved to treat localized areas of the skin and oral cavity. It is less often used to control pulmonary, gastrointestinal tract, or other sites of KS lesions. Localized KS lesions have also been effectively treated with intralesional injections of vinblastine.[ 9] Alitretinoin 0.1% gel provided local control in a randomized prospective multicenter trial.[ 10][Level of evidence: 1iiDiv ]
In epidemic KS, the already profoundly depressed immunologic status of the host limits the therapeutic usefulness of systemic chemotherapy. Systemic chemotherapy studies in epidemic KS have used as single agents or in combinations doxorubicin, bleomycin, vinblastine, vincristine, etoposide, paclitaxel, and docetaxel.[ 11-15][Level of evidence: 3iiiDiv ] The combination of cART and liposomal doxorubicin resulted in a 5-year OS of 85% in 140 patients with T1 disease.[ 3][Level of evidence: 3iiiDiv ]
Randomized multicenter trials showed an improvement in response rate (45%–60% vs. 20%–25%) and a more favorable toxic effects profile for pegylated liposomal doxorubicin or liposomal daunorubicin, compared to the combination of doxorubicin, bleomycin, and vincristine or bleomycin and vincristine.[ 16-18][Level of evidence: 1iiDiv ] During cART, both pegylated liposomal doxorubicin and paclitaxel are active single agents with response rates close to 50%.[ 19][Level of evidence: 1iiDiv ]
Biologic and targeted therapy
The interferon alphas have also been widely studied and show a 40% objective response rate in patients with epidemic KS.[ 20,21] In these reports, the responses differed significantly according to the prognostic factors of extent of disease, prior or coexistent opportunistic infections, prior treatment with chemotherapy, CD4 lymphocyte counts lower than 200 cells/mm³, the presence of circulating acid-labile interferon alpha, and an increase in beta-2-microglobulin. Several treatment studies have combined interferon alpha with other chemotherapeutic agents. Overall, these trials have shown no benefit with the interferon-chemotherapy combinations as compared to the single-agent activities.
Recombinant interferon alpha-2a and interferon alpha-2b were the first agents approved for the treatment of KS. Approval was based on single-agent studies performed in the 1980s before the advent of antiretroviral therapy. The early studies demonstrated improved efficacy at relatively high doses. High-dose monotherapy is rarely used today, and instead, interferon is given in combination with other anti-HIV drugs in doses of 4 to 18 million units. Neutropenia is dose limiting, and trials of doses of 1 to 10 million units combined with less myelosuppressive antiretrovirals are in progress. Response to interferon is slow, and the maximum effect is seen after 6 or more months. Interferon should probably not be used in the treatment of patients with rapidly progressive, symptomatic KS.
Imatinib, a c-kit/PDGF (platelet-derived growth factor) receptor inhibitor, resulted in partial responses in 10 of 30 previously treated patients (cART + chemotherapy).[ 22]
Bevacizumab, the humanized, antivascular, endothelial growth–factor monoclonal antibody, had a response rate in 5 of 16 patients who did not improve after the institution of cART and chemotherapy.[ 23][Level of evidence: 3iiiDiv ]
Interleukin-12 had a response rate of 71% (95% confidence interval, 48%–89%) among 24 evaluable patients in a phase I and phase II trial.[ 24][Level of evidence: 3iiiDiv ]
Treatment options under clinical evaluation:
- Patients with epidemic KS are appropriate candidates for clinical trials evaluating new drugs or biologicals.
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
- Safai B: Kaposi's sarcoma and acquired immunodeficiency syndrome. In: DeVita VT, Hellman S, Rosenberg S, eds.: AIDS: Etiology, Diagnosis, Treatment and Prevention. 4th ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1997, pp 295-318.
- Krown SE: Highly active antiretroviral therapy in AIDS-associated Kaposi's sarcoma: implications for the design of therapeutic trials in patients with advanced, symptomatic Kaposi's sarcoma. J Clin Oncol 22 (3): 399-402, 2004. [PUBMED Abstract]
- Bower M, Dalla Pria A, Coyle C, et al.: Prospective stage-stratified approach to AIDS-related Kaposi's sarcoma. J Clin Oncol 32 (5): 409-14, 2014. [PUBMED Abstract]
- Krell J, Stebbing J: Broader implications of a stage-guided stratified therapeutic approach for AIDS-related Kaposi's sarcoma. J Clin Oncol 32 (5): 373-5, 2014. [PUBMED Abstract]
- Cooper JS, Steinfeld AD, Lerch I: Intentions and outcomes in the radiotherapeutic management of epidemic Kaposi's sarcoma. Int J Radiat Oncol Biol Phys 20 (3): 419-22, 1991. [PUBMED Abstract]
- Nobler MP, Leddy ME, Huh SH: The impact of palliative irradiation on the management of patients with acquired immune deficiency syndrome. J Clin Oncol 5 (1): 107-12, 1987. [PUBMED Abstract]
- Singh NB, Lakier RH, Donde B: Hypofractionated radiation therapy in the treatment of epidemic Kaposi sarcoma--a prospective randomized trial. Radiother Oncol 88 (2): 211-6, 2008. [PUBMED Abstract]
- Berson AM, Quivey JM, Harris JW, et al.: Radiation therapy for AIDS-related Kaposi's Sarcoma. Int J Radiat Oncol Biol Phys 19 (3): 569-75, 1990. [PUBMED Abstract]
- Epstein JB, Lozada-Nur F, McLeod WA, et al.: Oral Kaposi's sarcoma in acquired immunodeficiency syndrome. Review of management and report of the efficacy of intralesional vinblastine. Cancer 64 (12): 2424-30, 1989. [PUBMED Abstract]
- Bodsworth NJ, Bloch M, Bower M, et al.: Phase III vehicle-controlled, multi-centered study of topical alitretinoin gel 0.1% in cutaneous AIDS-related Kaposi's sarcoma. Am J Clin Dermatol 2 (2): 77-87, 2001. [PUBMED Abstract]
- Evans SR, Krown SE, Testa MA, et al.: Phase II evaluation of low-dose oral etoposide for the treatment of relapsed or progressive AIDS-related Kaposi's sarcoma: an AIDS Clinical Trials Group clinical study. J Clin Oncol 20 (15): 3236-41, 2002. [PUBMED Abstract]
- Saville MW, Lietzau J, Pluda JM, et al.: Treatment of HIV-associated Kaposi's sarcoma with paclitaxel. Lancet 346 (8966): 26-8, 1995. [PUBMED Abstract]
- Lim ST, Tupule A, Espina BM, et al.: Weekly docetaxel is safe and effective in the treatment of advanced-stage acquired immunodeficiency syndrome-related Kaposi sarcoma. Cancer 103 (2): 417-21, 2005. [PUBMED Abstract]
- Gill PS, Tulpule A, Espina BM, et al.: Paclitaxel is safe and effective in the treatment of advanced AIDS-related Kaposi's sarcoma. J Clin Oncol 17 (6): 1876-83, 1999. [PUBMED Abstract]
- Di Lorenzo G, Konstantinopoulos PA, Pantanowitz L, et al.: Management of AIDS-related Kaposi's sarcoma. Lancet Oncol 8 (2): 167-76, 2007. [PUBMED Abstract]
- Stewart S, Jablonowski H, Goebel FD, et al.: Randomized comparative trial of pegylated liposomal doxorubicin versus bleomycin and vincristine in the treatment of AIDS-related Kaposi's sarcoma. International Pegylated Liposomal Doxorubicin Study Group. J Clin Oncol 16 (2): 683-91, 1998. [PUBMED Abstract]
- Northfelt DW, Dezube BJ, Thommes JA, et al.: Pegylated-liposomal 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 16 (7): 2445-51, 1998. [PUBMED Abstract]
- Gill PS, Wernz J, Scadden DT, et al.: Randomized phase III trial of liposomal daunorubicin versus doxorubicin, bleomycin, and vincristine in AIDS-related Kaposi's sarcoma. J Clin Oncol 14 (8): 2353-64, 1996. [PUBMED Abstract]
- Cianfrocca M, Lee S, Von Roenn J, et al.: Randomized trial of paclitaxel versus pegylated liposomal doxorubicin for advanced human immunodeficiency virus-associated Kaposi sarcoma: evidence of symptom palliation from chemotherapy. Cancer 116 (16): 3969-77, 2010. [PUBMED Abstract]
- Real FX, Oettgen HF, Krown SE: Kaposi's sarcoma and the acquired immunodeficiency syndrome: treatment with high and low doses of recombinant leukocyte A interferon. J Clin Oncol 4 (4): 544-51, 1986. [PUBMED Abstract]
- Groopman JE, Gottlieb MS, Goodman J, et al.: Recombinant alpha-2 interferon therapy for Kaposi's sarcoma associated with the acquired immunodeficiency syndrome. Ann Intern Med 100 (5): 671-6, 1984. [PUBMED Abstract]
- Koon HB, Krown SE, Lee JY, et al.: Phase II trial of imatinib in AIDS-associated Kaposi's sarcoma: AIDS Malignancy Consortium Protocol 042. J Clin Oncol 32 (5): 402-8, 2014. [PUBMED Abstract]
- Uldrick TS, Wyvill KM, Kumar P, et al.: Phase II study of bevacizumab in patients with HIV-associated Kaposi's sarcoma receiving antiretroviral therapy. J Clin Oncol 30 (13): 1476-83, 2012. [PUBMED Abstract]
- Little RF, Pluda JM, Wyvill KM, et al.: Activity of subcutaneous interleukin-12 in AIDS-related Kaposi sarcoma. Blood 107 (12): 4650-7, 2006. [PUBMED Abstract]
Recurrent Kaposi Sarcoma Treatment
The prognosis for any treated Kaposi sarcoma patient with progressing, recurring, or relapsing disease is highly variable. Deciding on further treatment depends on many factors, most importantly the clinical setting (i.e., classic, immunosuppressive treatment, or AIDS) in which the tumor arises as well as individual patient considerations.
Clinical trials are appropriate and should be considered when possible.
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
Changes to This Summary (01/30/2018)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board , which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of Kaposi sarcoma. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board , which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
- be discussed at a meeting,
- be cited with text, or
- replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Kaposi Sarcoma Treatment are:
- Eric J. Seifter, MD (Johns Hopkins University)
- Minh Tam Truong, MD (Boston University Medical Center)
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us . Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Kaposi Sarcoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/soft-tissue-sarcoma/hp/kaposi-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389335]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online , a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website's Email Us .
Updated: January 30, 2018
Source URL: https://www.cancer.gov/publishedcontent/syndication/3524.htm
Source Agency: National Cancer Institute (NCI)
Captured Date: 2013-09-14 09:01:43.0


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text:
We are a school on a twelve period day. Supposedly, to accommodate different schedules, our meetings are held various periods during the day. We still have to go to C-6 assignments. This means that the only free period we have is lunch. Ms. POd bitched because the only period she could attend gave her five classes in a row. Mr. AP gave her permission to go the the bathroom and get coffee first. What a guy!
The meeting consisted of his usual double talk and talking down to teachers. He again reminded us how we are here to help children. One of my kids went to him today because she is in the wrong math class. He had told her earlier in the semester to see him if the class was too hard. He proceeded to yell at her and tell her to tell her guidance counselor to change anything he wanted. He would not do the counselor's job. The kid was upset. She said, "I am a student. I cannot tell my counselor what to do." I ended up walking her into the counselor and helped get her straight. I might not say that my job is to help kids, but I do help them all the time.
One of the things he mentioned was the availability of a scholarship report. He told us all to stop by and see him about it. I asked if we could do this during the C-6 period. Of course I got yelled at. "Your job is to help kids. Don't mention contract. So what if you have to give up five or ten minutes of your lunch." Too bad he always mentions contract when we complain about the C-6 assignments. I guess the contract only works when it benefits him. I am not going to see him about these reports. I can't see any way that seeing them will help my students.
Quality review is giving our school a second look in a few days. We are all supposed to want that good grade so we will get good students. Our school is too crowded. We don't need any more students. Besides, the school is in a good, safe neighborhood. The kids will keep coming no matter what mark we are given. Administration wants the grade for their bonuses. I just want to be left alone. The only positive thing I can say about my school is that the administration is not as bad as the one Justice Not Just Us works for.


text:
Jennifer Lopez, who is coming back to judge American Idol, even though FOX hasn't officially officially confirmed it yet, covers the new issue of Cosmopolitan. She looks amazing. And I wish I could wear my hair like that without looking like an asshole full of Try. Maybe I'll test out the asshole full of Try at TIFF.
JLO addresses the controversy about the time she performed in Turkmenistan for the dictator earlier this year. Click here for a refresher. She was paid sick money for the appearance and, when called out for it, blamed it on ignorance, claiming she didn't know that the dude was a dick to his people. JLO explains further in the magazine:
"I know that being seen as a role model means taking responsibility for all my actions. I am human, and of course, sometimes I make mistakes. But I promise that when I fall, I get back up. When I am wrong, I will learn the lesson and move on to face other challenges. For me, that's what creating your own life is. Doing your best work while being your best self."
That is a skill, non? Turning an apology into a self-affirmation? The point of what you just read isn't that JLO was wrong. The point of what you just read is that JLO is awesome and can't be knocked down. There you go, Turkmens. Hope that makes you feel better for all your suffering.
As for her relationship with that Slum Bear, because JLO will always want to talk about her love life, she tells Cosmopolitan that:
"For me, it's about having a great partner to walk this life with. I have my own high standards for what I want in a partner and how I want to be treated. I bring a lot to the table. I'm not talking about material things but what I have to offer as a person – love and loyalty and all the things that make a good relationship. It's funny, early on with Beau, I remember telling him how I have a real button on being ignored. And he was like, 'Listen, if somebody ignores you, then forget them. They don't deserve to have your attention.' But it's funny. Sometimes when we don't get it, we try to get it in a negative way, you know?"
She's an entrepreneur and she's taking advice on being ignored from a Backup Bear, for real???
Click here for more from JLO in Cosmpolitan.


text:
Restarting the cluster nodes¶
Restarting a cluster node is as simple as shutting down and restarting standard mysql. The node should gracefully leave the cluster (and the total vote count for quorum should decrement). When it rejoins, the node should receive an IST of changes since it left so it can get back in sync. If the set of changes needed for IST are not found in the
gcache file on any other node in the entire cluster, then an SST will be performed instead. Therefore, restarting cluster nodes for rolling configuration changes or software upgrades should be fairly trivial to accomplish from the cluster's perspective.
If a configuration change is done and mysql restarted and that change happens to contain a misspelling or some other mistake that prevents mysqld from loading, Galera will generally decide to drop its state and an SST will be forced for that node.


text:
To the uninitiated, "yes."
|All Ye Who Enter:
Alligators lurk, and panthers too – but those worries are misguided:
The animal you really have to watch out for are water moccasins.
Not that they chase you – they won't!
Nor do they spook – they don't!
|Can you see the spider?
If not, you'll feel it on your face
when you unwittingly walk
into the web
Rather, it's because they don't spook when they hear you that causes the real fright. If you walk without caution in their path, you could be surprised by a strike when you least expect it.
And yes, that could bite.
There are giant spiders too!
But even worse is a trunk-to-trunk spanning web on your face (and in your hands as you try to remove it after the fact),
Is a spider there too, in my hair or crawling down my neck?
It rarely the case, but the thought certainly spooks!
|Craggily pond apple
forests look foreboding
The truth is that humans evolved to fear the swamps.
They are virtually uninhabitable by modern day standards, and efforts to inhabit them quite literally ruin whatever swamp was once there by way of digging, draining, filling, cutting, and building;
|The cypress are lovely,
dark and deep ...
Don't get lost!
Not to mention the real Frankensteins of the quagmire – Maleleuca trees, Brazilian Pepper, Old World Climbing Fern, pythons, plus every other invader ...
On the rapidly-spreading list of non-native invasives!
I'm here to tell you it's not we who should fear the swamps.
They are a misunderstood beauty in need of love instead.
The truth in actuality is quite the opposite:
It's the swamps that should fear us!
|In the right light:
Cypress aren't
so spooky after all!
Happy Halloween!


text:
Bertone's wedge-style design reached its apotheosis with the Lamborghini Countach. Which was itself a dramatic leap from the elongated and unbalanced design of the Urraco/Jalpa and seems almost magical until you consider this — the Lamborghini Bravo Concept. It's the forgotten link and an absolute, if slightly incomplete, masterpiece.
The angles of the car are even more stark when transposed against the glass roof of the building at the Villa d'Este 2011 where this car was auctioned off along other famous Bertone designs. Check out the entire photoset at formfreu.de if you're interesting in picking your ideal wedge.
Photo Credit: formfreu.de


text:
Meat Lite: Eggplant, Chicken, and Smoked Mozzarella Sandwiches Recipe
Mostly vegetarian dishes with just a touch of meaty accent.
Editor's note: Philadelphia food writers Joy Manning and Tara Mataraza Desmond drop by each week with Meat Lite, which celebrates meat in moderation. Meat Lite was inspired by their book, Almost Meatless.
A few months back when Serious Eats was cooking our book, Almost Meatless, there was lots of chatter about favorite nonmeat ingredients that boast meaty textures and flavors enough to make actual meat an afterthought or just completely unnecessary. If you cook an almost-meatless menu or a seriously meatless menu for most meals, these ingredients come in particularly handy.
One of the most mentioned of these nonmeat favorites was eggplant. Eggplant Parmesan, moussaka, stir fries, casseroles--the suggestions went on and on, and plenty of people mentioned that even meat-loving friends and family fell for the meatiness of meatless eggplant dishes.
In Almost Meatless, we use ingredients we call "Power Players." Smoked foods, including cheeses, leave an especially meatlike mark, likely because of our association (consciously or not) with the smoky flavor of the most beloved of all meat, bacon.
This sandwich uses both marinated eggplant and smoked mozzarella with a little bit of thinly sliced chicken and roasted red peppers. It's easy enough for vegetarians at to omit the chicken on their sandwiches while everyone else assembles a meat lite version.
"Chicken cutlets" are thinly sliced and pounded pieces of boneless, skinless chicken breast. You can either buy the cutlets or make your own from full chicken breasts (as described below).
- 1 pound boneless skinless chicken breasts (2 medium) or chicken breast cutlets
- 2/3 cup red wine vinegar
- 1/4 cup olive oil
- 2 cloves garlic, minced
- 1 large shallot, minced
- 4 sprigs of thyme, leaves only, minced
- 2 teaspoons salt
- 1/2 teaspoon freshly ground black pepper
- 1 medium eggplant (about 1 pound), sliced into 1/4-inch rounds
- 1 red bell pepper
- 8 ounces smoked fresh mozzarella, sliced thin
- 1 baguette cut into 4 pieces or 4 sandwich (hoagie) rolls
If using full chicken breasts (instead or chicken cutlets), slice the meat into 1/2-inch thick strips and then pound each strip thin.
Make a marinade by whisking together the vinegar, oil, garlic, shallot, thyme, salt, and pepper in a mixing bowl. Put the eggplant in a zip top bag or a glass dish. Pour half of the marinade over the eggplant. Put the chicken in a separate bag or dish and pour the other half of the marinade over it. Refrigerate the eggplant and chicken for about an hour.
Heat a grill to medium-high. Put the bell pepper on the hot grill and grill each side until blackened all over. Remove to a bowl and cover with plastic wrap. When cool enough to handle, peel the charred skin from the pepper and slice into 1-inch strips.
Grill the marinated eggplant and chicken until the eggplant is tender and the meat is cooked through.
Arrange slices of smoked mozzarella on each piece of baguette. Top with pieces of hot chicken, eggplant and roasted peppers.
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Vintage video...
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Vintage video...
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Trouble Maker | Black Vinyl
Inkl. Gesetzlicher MwSt. Zzgl. Versandkosten
Weitere Informationen
Track Listing:
- Track Fast
- Ghost of a Chance
- Telegraph Avenue
- An Intimate Close Up Of A Street Punk Trouble Maker
- Where I'm Going
- Buddy
- Farewell Lola Blue
- All American Neighborhood
- Bovver Rock and Roll
- Make it Out Alive
- Molly Make Up Your Mind
- I Got Them Blues Again
- Beauty of the Pool Hall
- Say Goodbye to Our Heroes
- I Kept a Promise
- Cold Cold Blood
- This is Not the End
This purchase includes a digital download of the single "Ghost of a Chance" as well as the entire album. You will be emailed a link to access "Ghost of a Chance" shortly after purchase. You will be emailed a link to access the full album download on the release date.


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WGBH Openvault
Making Things Grow; Artificial Lighting
License Clip
More material may be available from this program at the WGBH Archives. If you are a researcher interested in accessing the collection at WGBH, please email firstname.lastname@example.com.
This program has not been digitized yet or cannot be made available on Open Vault.
- Series
- Making Things Grow
- Program
- Artificial Lighting
- Program Number
- Series Description
WGBH program hosted by Thalassa Cruso on indoor gardening. Cruso is archeologist turned horticulturist who demonstrated how to successfully grow plants. Series release date: 1967
- Program Description
Series Description: WGBH program hosted by Thalassa Cruso on indoor gardening. Cruso is archeologist turned horticulturist who demonstrated how to successfully grow plants.
- Asset Type
Broadcast program
- Media Type
- Genres
- Instructional
- Topics
- Gardening
- Citation
- Chicago: "Making Things Grow; Artificial Lighting," WGBH Media Library & Archives, accessed September 29, 2020, http://openvault.wgbh.org/catalog/V_855609F2D30543DCBC7E955758725CAA.
- MLA: "Making Things Grow; Artificial Lighting." WGBH Media Library & Archives. Web. September 29, 2020. <http://openvault.wgbh.org/catalog/V_855609F2D30543DCBC7E955758725CAA>.
- APA: Making Things Grow; Artificial Lighting. Boston, MA: WGBH Media Library & Archives. Retrieved from http://openvault.wgbh.org/catalog/V_855609F2D30543DCBC7E955758725CAA
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Federal Judge Unswayed by Microsoft's Objections to Data Demands
Aug 4, 2014 12:51 PM PT
Microsoft's objections to a court order requiring it to turn over a customer's emails held on a server in Ireland have been rejected.
Judge Loretta Preska of the U.S. District Court for the Southern District of New York last week issued an oral ruling in the case, reportedly saying the Electronic Communications Privacy Act of 1996 (ECPA) authorizes such extraterritorial collections of data by the U.S. government.
The ruling "suggests that courts can disregard the limits to traditional evidence gathering for digital data and leaves open the possibility [that] other courts interpreting ECPA and 'warrants' issued under ECPA can disregard other inherent limits to that power," Hanni Fakhoury, a staff attorney at the Electronic Frontier Foundation, told the E-Commerce Times.
The judge stayed her ruling to give Microsoft time to file an appeal, which the company said it would do.
What the Fuss Is All About
U.S. Magistrate Judge James Francis late last year issued a search warrant requiring Microsoft to turn over all the data requested in a warrant to the U.S. authorities.
Microsoft refused, contending that warrants issued by U.S. courts do not apply in other countries.
In April, Judge Francis denied Microsoft's motion to quash the warrant in part. Microsoft appealed that ruling to Judge Preska's court.
Judge Preska's Argument
Judge Preska reportedly reasoned that she saw no difference between a company's own records and a customer's email.
She also endorsed Judge Francis' ruling, which held that Microsoft simply could copy the emails from the U.S.
Judge Preska reportedly drew on a Department of Justice case in 1984, in which it was held that a court could require a company to disclose its business records no matter where in the world those records might reside. Such disclosure would not require the consent of the country in which they were stored.
Preska held that the ECPA implicitly authorizes the extraterritorial collection of data because Congress was aware of the ruling in that case and therefore implicitly authorized extraterritorial gathering of data.
Mike Houlihan of Waggener Edstrom referred the E-Commerce Times to an earlier statement by General Counsel Brad Smith, indicating the company would file an appeal.
Objections to the Latest Ruling
"One of the problems with the magistrate's opinion now affirmed by Judge Preska is that it reinterpreted the word 'warrant' in ECPA to mean something different than it has traditionally meant, namely that an ECPA 'warrant' can extend extraterritorially, which a traditional warrant cannot," Fakhoury pointed out.
Judge Preska's assumption that a customer's stored emails are the business records of Microsoft is flawed, Jim Dempsey, senior counsel at the Center for Democracy & Technology, told the E-Commerce Times.
Those emails "are the property of the subscriber, and the U.S. government should not be able to force Microsoft or anyone else to perform a search and seizure of property in another country," he fumed.
Rule of Law?
Data held on servers in Ireland is protected by mutual legal assistance treaties, Daniel Castro, a senior analyst at the Information Technology and Information Federation, told the E-Commerce Times. "If that process doesn't work, countries should work to fix it -- not circumvent it by compelling access to data."
Whether or not the U.S. government has the authority to compel seizure of data overseas, it's bad policy, Castro said. Other countries might follow suit or retaliate by making it illegal for companies to turn over data under those conditions, "creating a Catch-22 for companies in multiple jurisdictions."
Fallout From the Ruling
U.S. exporters of high-tech services are reeling from revelations about the National Security Agency's surveillance activities, and this ruling "could see the center of cloud services technology shifting from the U.S. to Europe or Asia if those countries don't implement extraterritorial data gathering," said Rob Enderle, principal analyst at the Enderle Group.
Companies likely will spin out their foreign subsidiaries at arm's length as an investment, he told the E-Commerce Times, the way IBM did with its African and German holdings during World War II and with its South African properties during the era of apartheid in South Africa.


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Channel ConflictBy Jeffrey Rothfeder
Trend: Cross-Selling
Allied Office Products Inc. doesn't have the luxury of waiting for revenue to walk into its store. The $300 million Clifton, N.J.-based seller of office supplies and services to small businesses throughout the Northeast has a team of more than 200 salespeoplefeet on the street, as they're called by company executiveswho work door-to-door and phone call by phone call to line up new customers and squeeze additional orders from existing ones.
"We're a head-count business: I know that if you have a 60-person office, you should buy $300 worth of basic office suppliespaper, pens, staplesfrom us with each order," says Mike Palmer, Allied's CoO. "But if that's all we get, we stagnate. For us to grow, we have to convince the customer, who already likes our products and service, to buy more than just basic supplies; we have to increase the order by 10, 20 or 30 times."
That job is given to Allied's "specialists": salespeople who are trained to push the company's less traditional, higher-margin lines such as coffee and refreshments, printing and forms management, and office furniture. Specialists split the commission with their local account executives, who in the past were responsible for alerting
specialists to customers they should contact. With that approach, however, a lot of opportunities slipped through the cracksoften because the specialists were never told about them. Some account execs were wary of other Allied sales staff coming into their territories, even if it meant the possibility of additional income, while others simply forgot to pass along the leads.
So last year, Palmer installed a new sales-force system that automatically does what many account executives didn't do: It generates ranked lists of customers based on order size, type of business, items purchased and other categories. As these leads are received, specialists are required to follow up and enter into the system the results of their contact with the customereverything from "no interest," to "left a message," to "set up an appointment," to "signed up an additional $12,000 order for printing services." These outcomes are then collected in reports that provide Allied management with a day-by-day analysis of sales efforts, viewed through any number of variablesrevenue by specialist, size of customer orders, and length of time a lead remains opened, for instance.
"The system has energized our sales force," says Palmer. "It relieves the account executive of having to reach out to the specialist, while vastly increasing our company-wide knowledge of sales opportunities and improving our ability to send the sales specialist in after them. It's made a big difference in our performance."
Divide and Conquer
Divide and Conquer
It's called cross-selling, or up-selling: a data-driven technique companies use to increase revenue by targeting existing customers with fresh products and services that will most likely match their preferences. As a concept, cross-selling isn't new. For the past decade or so, companies have been touting the benefits of tapping old customers for new revenue, primarily because it makes good strategic sense. In a 2001 study, Harvard Business School professors Robert S. Kaplan and V.G. Narayanan examined the marketing adage that 20 percent of customers provide 80 percent of sales. Their conclusion: Not only is that ratio on the mark, but 20 percent of customers also account for well over 100 percent of profits. Combine those numbers with the fact that it costs companies five times less to cross-sell an existing client than to acquire a new one, and it's hard to deny that cross-selling is a profitable approach, particularly when a tough economic environment is making consumers finicky.
The problem is, as much as cross-selling has been a desirable goal, few companies do it well. According to MarketSoft Corp., a provider of cross-selling technology, nearly three-quarters of all businesses say they have cross-selling programs, but as many as 70 percent of such efforts fail to increase revenue in any significant way, according to Gartner Inc. One prominent reason: Lots of corporations spent the 1990s bulking up through acquisitions, but integrating the companies and divisions involved in these deals and finding the vaunted synergies that might lead to cross-selling has been tough. Instead of cooperation and data-sharing among business units, information silos have emerged. And in the process, individual business units have grown in influence. They're held to specific performance yardsticks and control their own sales-generation techniques and costs, including technology expenditures. What is typically viewed as cross-selling by many companies is little more than internal referrals within highly segregated divisions. Sometimes that results in incremental sales, but nothing substantial, because essentially the same products are being offered to the same customers over and over again.
"It's like a soccer game. If everybody plays as individuals, the team loses," says Mike Kozub, vice president and chief marketing officer of MarketSoft Corp., a cross-selling technology provider. "For instance, Citicorp has dozens of independent business units that all have insights into the same customers. If they shared what they know, Citicorp would be much more formidable. But not many business units in any company are able to communicate across lines of business very well."
Despite its stutter-start, the full promise of cross-selling is finally being put to the test by many companies, especially those in the financial-services, telecommunications, high-tech and services industries. As the economy has shrunk, the value of existing customers has increased; they're one of the few avenues for revenue growth companies have. Consequently, many senior executives are increasingly determined that no customers slip through the cracks without every appropriate business unit getting a chance to see what else they might buy. At the same time, it's almost impossible for a consumer to stay anonymous anymore. Shopping on the Web, call centers and third-party firms that collect virtually every transaction from hundreds of companies have vastly increased the amount of information available about individual customer activities and preferences (see "Connecting the Dots"). Put all that together and a tipping point for new and more ambitious attempts at cross-selling has been reached.
"Companies have amassed a tremendous amount of data about their own customers, mostly through the implementation of new technologies to gather this information," says Darius Vaskelis, a vice president at strategy consultants Inforte Corp. "Now, executives are demanding that better use is made of this data and that their companies focus on selling a broader portfolio to their customers."
Cross-selling's inroads have come in the wake of increasing disenchantment with customer relationship management (CRM) systems. By automating record-keeping and access to data, these expensive systems were supposed to drive the handling of interactions with customers and maintained account information to a new level of efficiency. While CRM by and large has succeeded at making it easier to provide services to customers through data-rich call centers and account records readily available on desktops throughout the company, it has generally added very little to the top or bottom line. In a 2002 survey of 23 users of CRM software from Siebel Systems by analysts at Nucleus Research Inc., 61 percent said they had not yet achieved a positive return on investment after at least two years with the technology.
"Typically, CRM systems just look at data from a historical perspective," says Heidi Lanford, senior vice president of analytics at KnowledgeBase Marketing Inc., CRM and cross-selling consultants and a subsidiary of advertising agency Young and Rubicam. "It's hard to measure a return on investment from that."
By contrast, cross-selling at its best depends on a forward-looking, even predictive technology. Drawing upon the vast amount of poorly used data captured by most companies in their CRM systems, cross-selling's biggest advantage comes when it is used as an übersystem, gathering information from each business unit to produce a broad, company-wide assessment of customer purchasing behavior and propensity. Based on this, cross-selling can attempt to forecast which customers are most likely to buy which additional products.
Fleet of Foot
Fleet of Foot
FleetBoston Financial Corp. is an apt example. Since 1988, Fleet has acquired nearly 30 financial-services firms, including the $1.6 billion acquisition of discount broker Quick&Reilly in 1998 and the $16 billion purchase of BankBoston a year later. By 2002, this hodgepodge had left Fleet with a set of four distinct product linessecurities brokerage, mortgages, small-business banking and personal bankingeach with its own sales force, call center and consumer contact points in branches and on the Web. With tens of thousands of employees spread among these units, account representatives infrequently broadcast leads by e-mail or fax to people in other departments; usually they didn't know the correct contacts. And with Fleet operating an increasingly streamlined operation, they often didn't have the time.
"The most basic illustration of this is when a teller, during a routine transaction in which he learns that you may be needing a mortgage, advises you to go see the lending officer behind the desk," says MarketSoft's Kozub. "Nine times out of ten, or more, you don't have the time and you leave the bank without following up. That's a lead between two separate departments that's lost within a branch, within ten feet maybe. Imagine how many leads evaporate when they have to travel long distances to reach an anonymous person someplace else."
In January 2002, Fleet announced plans to pilot software from MarketSoft that, simply put, links up the CRM systems in each of the firm's four units. Using a Web interface, employees can enter potential customer leads, which are then enhanced with information from corporate databases and delivered to the sales-force automation system in the division with the most appropriate sales rep. A call center employee in personal finance can type into the computer the name of a checking account customer who happened to mention that he plans to open a Segway HT and scooter store. The system seeks any other information in Fleet's computers about this customer and ranks him by such things as activity with Fleet; history of responding to telemarketing calls, e-mails or paper mail; and any known financial data, such as assets or outstanding loans. Having set a priority rating on this lead, the system then sends the customer's information to an agent in the small-business unit, who contacts the customer. Each lead includes a tag that tracks its location as it moves through the system, helping monitor the outcome of sales efforts.
MarketSoft's system employs a series of programmed rules to regulate the ranking of leads as well as how they should be generated and distributed. These rules can be changed frequently and quickly with natural language input to suit, for instance, specific sales campaigns or new-product testing. Most cross-selling systemswhether proprietary or from PeopleSoft, KnowledgeBase Marketing, Siebel or any of the other numerous suppliersoffer similar dynamic, macro-based programming approaches that respond rapidly to changing business conditions and avoid the months-long programming efforts that traditional IT departments require.
Fleet remains enthusiastic about the results of its cross-selling campaign. Brad Warner, Fleet Financial's vice chairman, describes the use of technology as an attempt to "seize the revenue potential of our existing customer base." Fleet's enhanced focus on cross-selling over the past 21/2 years has increased the company's cross-sell ratio to 3.7 products per house-hold from 2.7 in 2001. And Fleet trumpets this statistic in its annual report and in its presentations to Wall Street analysts to defend its claims that its financial performance is on the upswing.
Channel Conflict
Channel Conflict
More than anything, cultural issues at companies are the prime hindrance to a successful cross-selling effort. Creating an incentive program for salespeople that gives them a piece of the commission, whether they actually complete the transaction with customers or just refer them through a cross-selling program, is critical. But to do this often requires a radical rewriting of the way most organizations operate.
Consider the persistent conflict between the Internet, store and catalog sales channels at many companies. Too often, these are separate business units, so they tend to market to customers independentlyin effect, competing with each other. So it's not unusual for a company to have healthy annual Web sales growth of 25 percent or more, even on an established site, while sales increases for the total business remains stuck in the single digits. But if these separate sales units are forced to cooperate by using a cross-selling system as both an analytical tool and the foundation of a marketing campaign, it's possible to figure out how to drive customers from one channel to another without diminishing overall sales.
Home furnishings retailer Restoration Hardware Inc. was an entirely store-based operation until 1998, when it produced its first catalog. A year later, the company debuted its Web site. Sales quadrupled between 1998 and 2002, but so did costs: The company posted a record loss of $34 million in 2002. Concerned that high marketing costs, especially on the catalogs, were washing out revenue growth, management decided to investigate the impact of the catalog on the Web and retail sales channelsan analysis that, surprisingly, relatively few companies undertake. Working with consultants from Abacus, a provider of retail transactional data and other customer information, the company matched each of its Web, retail and catalog purchases to specific mailings. The results were extremely valuable and somewhat surprising: More than 40 percent of online purchases were linked to the catalog, and these customers spent 30 percent more than other Restoration Hardware Web shoppers. Also, consumers who received the company's catalog spent 25 percent more in its stores than those who didn't.
Based on these findings, Restoration Hardware increased its cross-selling effort significantly by doubling its catalog run last year and mailing 80 percent of these catalogs to existing customers, who were chosen on the strength of their past purchasing behavior and their potential as repeat customers. With the goal of raising the dollar value of purchases in each sales channel by at least 20 percent, the catalog was redesigned with higher-priced, higher-margin productsitems such as Moonpies and funny glassware were replaced with textiles, rugs, top-quality sheets and draperies.
"This analysis had an incredible impact in helping us make marketing decisions," says Christine Parish, the former director of catalog marketing and now a consultant to the Corte Madera, Calif.-based company. "And now that we can see how each channel's sales are impacted by catalog mailings, we have a methodology for calculating and charging each channel its fair share of the costs."
According to marketing experts, a successful cross-selling system demands three essential technological and cultural requirements: a comprehensive database detailing the purchasing activities of each customer; company-wide dedication to cross-selling led by senior executives and demonstrated by incentives to encourage employees to share data and the discipline to measure results in real time; and a computerized delivery system to generate and distribute sales leads throughout the company.
A system drawn from those criteria, MarketSoft's Kozub says, would view "sales opportunities as assets"valuable company property and the building blocks for revenue and earnings growth. "They should be treated the same way raw materials are assets on a factory floor," says Kozub.
That message has taken on some urgency recently as companies find it more and more difficult and expensive to generate new customers, while many have failed to develop deep and long-lasting relationships with existing customers. Ballooning sales in the 1990s led many companies to take their customers lightly, thinking there were plenty more where they came from. The increasing popularity and drive to finally make cross-selling work at more and more companies puts the lie to that attitude.
"In industry after industry, handling an account for the long haul wasn't a priority," says Inforte's Vaskelis. "There was too much money floating around and too many customers willing to spend it. So a company would install a CRM system and think that's enough spent on keeping customers happy. It wasn't. Now companies have to learn again how to manage customer relationships."
Cross-Selling Success: A Rainmaker's Guide to Professional Account Development
By Ford Harding
Adams Media Corp., August 2002
"Customer Profitability Measurement and Management"
By Robert S. Kaplan and V.G. Narayanan
Harvard Business School, May 2001
Web Sites
CRM Today


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text:
Paint quality is meaningless if it does not express quality of feeling.
— Adolph Gottlieb
Adolph Gottlieb's painting Apaquogue contains two main areas that provide excellent examples of Action Painting and Color Field painting, the subcategories of Abstract Expressionism suggested by art historians. The lower areas of energetically painted, black brushstrokes are emblematic of Action Painting—the flowing, energized application of paint on the canvas that is associated with Jackson Pollock, Franz Kline, and Willem DeKooning. The bright, faded-edged circles in the top portion of the canvas are used in much the same way that color was used by Mark Rothko, Helen Frankenthaler, and Ad Reinhardt—as purely expressive elements, rather than representational tools. Gottlieb's Apaquogue belongs to his Burst series (a reference to the circles), and calls to mind a landscape. The horizontal orientation, the brushy strokes at the bottom, and the circles above, which seem to reference suns, moons, or planets, all assert that the painting is about some sort of place. In fact, the title Apaquogue comes from the name of a road near the ocean close to the artist's home. Yet, rather than telling the viewer what this place looks like, Gottlieb's piece offers us some hints as to how he feels about this setting, and perhaps others. The black brushstrokes possess an energetic and flowing movement, possibly from the sea, the tall grasses near the water, or the reflections of light on whatever is at his feet. The colored circles, with their faded edges, seem to exist with a kind of radiating stillness, as if far away. It is through these few abstract elements that Gottlieb communicates the emotional impact a place can have on us.


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text:
recipe ingredients
2 thick cod filets, about 6 ounces each
1/2 cup frozen chopped spinach, thawed
1/2 cup nonfat cottage cheese
1 egg white
4 Tbsp. nonfat croutons, crushed
1/2 tsp. minced garlic
2 Tbsp. chopped onion
salt and pepper to taste
2 tsp. cornmeal
fresh lemon juice
recipe directions
Preheat oven to 425*F. Slice center of each cod filet about halfway through thickness to make a pocket. Spread open and spray with butter flavored cooking spray. Combine remaining ingredients (except cornmeal and lemon juice) in a small bowl. Divide stuffing evenly between the two filets, packing mixture into the pocket and mounding on top. Sprinkle with lemon juice, then sprinkle cornmeal over exposed side of fish. Bake for about 25 minutes or until fish is flakey.