Particle Beam Therapy Tolerance and Outcome on Patients with Autoimmune Diseases: A Single Institution Matched Case–Control Study

Abstract

It is unclear whether autoimmune diseases (ADs) may predispose patients to higher radiation-induced toxicity, and no data are available regarding particle therapy. Our objective was to determine if cancer patients with ADs have a higher incidence of complications after protons (PT) or carbon ion (CIRT) therapy. METHODS. In our retrospective monocentric study, 38 patients with ADs over 1829 patients were treated with particle therapy between 2011 and 2020. Thirteen patients had collagen vascular disease (CVD), five an inflammatory bowel disease (IBD) and twenty patients an organ-specific AD. Each patient was matched with two control patients without ADs on the basis of type/site of cancer, type of particle treatment, age, sex, hypertension and/or diabetes and previous surgery. RESULTS. No G4–5 complications were reported. In the AD group, the frequency of acute grade 3 (G3) toxicity was higher than in the control group (15.8% vs. 2.6%, p = 0.016). Compared to their matched controls, CVD–IBD patients had a higher frequency of G3 acute complications (27.7 vs. 2.6%, p = 0.002). There was no difference between AD patients (7.9%) and controls (2.6%) experiencing late G3 toxicity (p = 0.33). The 2 years disease-free survival was lower in AD patients than in controls (74% vs. 91%, p = 0.01), although the differences in terms of survival were not significant. CONCLUSIONS. G3 acute toxicity was more frequently reported in AD patients after PT or CIRT. Since no severe G4–G5 events were reported and in consideration of the benefit of particle therapy for selected cancers, we conclude that particle therapy should be not discouraged for patients with ADs. Further prospective studies are warranted to gain insight into toxicity in cancer patients with ADs enrolled for particle therapy.

The Normal, the Radiosensitive, and the Ataxic in the Era of Precision Radiotherapy: A Narrative Review

“…At the other end of the age spectrum, the susceptibility to late toxicities in the elderly seems to involve not only a decline in the wound healing factor but also a shift in the mechanisms of radiation-induced cell death towards senescence, a deficit in DNA damage response, and an increase in oxidative stress and inflammatory response, interconnected with the frequently associated comorbidities [ 57 ]. Some acquired conditions (comorbidities) such as metabolic disorders including diabetes mellitus [ 58 ], hypertension [ 59 , 60 , 61 ], obesity (bolus effect) [ 62 ], infectious diseases including HIV infection [ 63 ], autoimmune or systemic inflammatory diseases including connective tissue and inflammatory bowel diseases [ 64 , 65 , 66 ] are associated with increased rates and severity of RT toxicities. The Charlson comorbidity index adjusted for age and the Adult Comorbidity Evaluation-27 (ACE-27) [ 67 , 68 ] showed different results when applied in different oncological settings, and its role remains controversial in predicting iRS.…”