Acute and late reactions to radiation therapy in patients with collagen vascular diseases

Abstract

Background. A commonly held belief is that patients with collagen vascular diseases (CVD) have a greater risk of radiation therapy complications than patients without CVD. This impression is based on anecdotal reports, however. Methods. A group of 61 patients with CVD were compared with a matched control group of 61 patients without CVD. The CVD group included 39 patients with rheumatoid arthritis (RA), 13 with systemic lupus erythematosus (SLE), 4 with systemic sclerosis (scleroderma) (SSc), 4 with dermatomyositis, and 1 with polymyositis. The control group was matched with respect to age, sex, tumor site and histologic characteristics, treatment aim, general treatment method, radiation therapy technique, site irradiated, radiation dose, date of treatment, and follow‐up. Results. Overall, there was no significant difference between the CVD and control groups in terms of acute (11% versus 7%, respectively) or late complications (10% versus 7%, respectively). This was also true when only patients who were treated definitively were considered. Furthermore, none of the patients treated palliatively had complications. Three patients in the CVD group had fatal complications, compared with none in the control group. RA was associated with a slight increase in late complications in the definitively treated patients, whereas SLE was associated with a slight increase in acute reactions. No significant acute or late reactions were observed in the patients with SSc, dermatomyositis, or polymyositis. Conclusions. In general, these differences are less than expected and not statistically significant. Consequently, from these data, the authors could not show a significant increase in radiation therapy complications for patients with CVD.

Toxicity of radiotherapy in patients with collagen vascular disease

“…However, 2 separate matched control studies failed to observe any increased risk of acute or late complications in patients with CVD versus patients without CVD. 9,10 To our knowledge, the current study is the largest matched-control analysis of acute and late complications in patients with CVDs receiving RT. Unlike the other matched control studies, 9,10 we did find that a diagnosis of a CVD increased the risk of having any late toxicity, with a trend toward increased severe late toxicity.…”

“…[1][2][3][4][5][6][7][8] However, 2 separate matched control studies failed to observe any increased risk of acute or late complications in patients with CVD versus patients without CVD. 9,10 Other publications suggested that patients with nonrheumatoid arthritis CVD, 11,12 or patients with specific subtypes of CVD, may be at increased toxicity risk. [13][14][15] Further complicating the issue is the finding that some commonly prescribed medications, many of which are used in patients with CVD, may alter the radiation toxicity profile.…”

Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update

“…The effect of these factors in different studies often varies substantially. Until more definitive evidence is available, using its best clinical opinion, the panel recommends that such a strategy or risk estimation include assessment of patient age as it affects the risk of LRF, 7,10,21,22,38,39 estimated life expectancy in relation to age and comorbid conditions that might reduce life expectancy [40][41][42][43][44] or increase the risk of complications, 45 16,19,20 ). Several groups have proposed prognostic models to estimate the risk of LRF after mastectomy by combining several of these factors.…”

Malignant lymphoma associated with Behçet’s disease: A report of 2 cases

“…Numerous studies report that CVD predisposes patients to increased toxicity from therapeutic irradiation [34][35][36][37][38]; however, considering the effects of RT in patients with BD, the literature is lacking sufficient data, as there are only a few reports on the use of radiation in BD patients. In a part of these reports, the authors had not been referred to radiation toxicity [16,18,20,39].…”