Post-irradiation morphoea

Abstract

We present details of nine patients who developed morphoea after radiotherapy. In every patient morphoea began within the irradiated area and in four spread beyond it. We believe the irradiation triggered the morphoea despite the absence of any clear-cut relationship to dosage or severity of the acute reaction. Dermatologists and radiation oncologists should be aware that this condition may lead to the mistaken diagnosis of a local tumour recurrence.

Post-Irradiation Morphea: Case report and review of the literature

“…As summarized in Table 1 all -except 7 -cases (54 patients) of post-irradiation morphea (PIM) had breast carcinoma: 4 cases had endocervical and endometrial carcinoma, [9][10][11][12] one case had abdominal aortic aneurysm and was treated with fluoroscopically guided repair of abdominal aortic aneurysm (X-rays with fluorscent screen) which induced post-irradiation morphea (PIM), 13 one case after chest wall irradiation for subcutaneous lymphoma, 5 and one with axillary-node irradiation due to adenocarcinoma of unknown origin. 9 Analyzing the reported cases of PIM, we found an interval between the first radiotherapy dose and the appearance of PIM of 1 month 8 to 32 years. 14 In the literature few other skin disease associated with PIM were reported such as 2 cases with PIM and lichen sclerosus et atrophicans.…”

“…3 Furthermore radiation induced injury or reactions (dermatitis, edema, etc) involved in the pathogenesis of post-irradiation morphea (PIM) does not appear to be related to the dose of radiation or the severity of the acute tissue reaction to radiation. 9 The fundamental differences between PIM and RIF (radiation induced fibrosis) are that PIM occurs later in relation to the radiation exposure (mostly 1 month -3 years or more) compared to RIF, which usually occurs in the first 3 months. There is often an abrupt onset in PIM, with an initial erythema and induration which is not seen in RIF.…”

The rationale behind autologous autoimmune hematopoietic stem cell transplant conditioning regimens: concerns over the use of total-body irradiation in systemic sclerosis

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Scleroderma is a vascular disease marked by fibrosis, similar to what is often observed in late radiation injury. In normal individuals (ie no autoimmune disease), radiation therapy has been reported to be the initiating event for development of localized scleroderma usually within the radiation port but also at sites distal to the radiation field.…”

“…In normal individuals (ie no autoimmune disease), radiation therapy has been reported to be the initiating event for development of localized scleroderma usually within the radiation port but also at sites distal to the radiation field. [22][23][24][25][26][27][28][29] In patients with scleroderma, numerous papers have reported severe radiation-induced toxicity. [30][31][32][33][34] When using high-dose (40-70 cGy) localized radiation to treat cancer in patients with scleroderma, radiation-related injury may extended beyond the radiation field and causes death in approximately a third of patients and/or severe fibrosis overlapping the radiation field in the survivors.…”

Scleroderma and Breast Cancer

“…In humans loss of stromal caveolin-1 is a novel breast cancer biomarker that predicts early disease recurrence, metastasis, survival, and tamoxifen resistance. 34 Post irradiation morphea was first described in 1905, the first large series in 1989 35 . Radiotherapy for breast cancer can induce scleroderma through various mechanisms.…”