Toxicity of radiotherapy in patients with collagen vascular disease

Abstract

BACKGROUND.A diagnosis of collagen vascular disease (CVD) may predispose to radiotherapy (RT) toxicity. The objective of the current study was to identify factors that influence RT toxicity in the setting of CVD.METHODS.A total of 86 RT courses for 73 patients with CVD were delivered between 1985 and 2005. CVD subtypes include rheumatoid arthritis (RA; 33 patients), systemic lupus erythematosus (SLE; 13 patients), scleroderma (9 patients), dermatomyositis/polymyositis (5 patients), ankylosing spondylitis (4 patients), polymyalgia rheumatica/temporal arteritis (4 patients), Wegener granulomatosis (3 patients), and mixed connective tissue disorders (MCTD)/other (2 patients). Each patient with CVD was matched to 1 to 3 controls with respect to sex, race, site irradiated, RT dose (±2 Gray), and age (±5 years).RESULTS.There was no significant difference between CVD patients (65.1%) and controls (72.5%) experiencing any acute toxicity. CVD patients had a higher incidence of any late toxicity (29.1% vs 14%; P = .001), and a trend toward an increased rate of severe late toxicity (9.3% vs 3.7%; P = .079). RT delivered to the breast had increased risk of severe acute toxicity, whereas RT to the pelvis had increased risk of severe acute and late toxicity. RT administered in the setting of scleroderma carried a higher risk of severe late toxicity, whereas RT to SLE patients carried a higher risk of severe acute and late toxicity.CONCLUSIONS.Although generally well tolerated, RT in the setting of CVD appears to carry a higher risk of late toxicity. RT to the pelvis or in the setting of SLE or scleroderma may predispose to an even greater risk of severe toxicity. These issues should be considered when deciding whether to offer RT for these patients. Cancer 2008. © 2008 American Cancer Society.

Acute skin toxicity management in head and neck cancer patients treated with radiotherapy and chemotherapy or EGFR inhibitors: Literature review and consensus

“…Co-morbidities (such as rheumatoid arthritis, lupus erythematosis, or scleroderma, etc.) Pre-existing connective tissue or autoimmune diseases, including scleroderma, lupus erythematosis, and perhaps rheumatoid arthritis (RA), unpredictably predispose patients to the development of severe radiation dermatitis [36][37][38][39]. At any rate, the studies that support this statement are retrospective with small numbers of patients and use different scoring scales for complications.…”

Pelvic radiation disease: Updates on treatment options

“…Therapy-related factors include radiation dose, volume of irradiated bowel, time-and dose-fractioning parameters and concomitant employment of chemotherapy. Patientrelated factors include smoking, body mass index, previous abdominal surgery and comorbidities like inflammatory bowel disease, diabetes and collagen vascular disease [7][8][9][10][11][12][13] . Traditionally, the development of radiation enteropathy was explained through the "target cell" theory, which addressed early pathology to the epithelial injury, while fibroblast and endothelial cell damage was accounted for late-onset harm [14] .…”

Localized Morphea – a Rare but Significant Secondary Complication Following Breast Cancer Radiotherapy

“…In an analysis of 86 radiotherapy series in patients with CVDs, compared with one to three control cases of the same age, sex and location irradiated [18], there are no significant differences regarding acute reactions in the area irradiated (65.1% for those with CVD compared to 72.5% for the controls). However, the rate of chronic radiation reactions is significantly increased (29.1% for those with CVD compared to 14% for the controls; p = 0.001).…”