Journal of Clinical Oncology, Vol 15, 2728-2735, Copyright © 1997 by American Society of Clinical Oncology
Irradiation in the setting of collagen vascular disease: acute and late complications
MM Morris and SN Powell
Department of Radiation Oncology, Massachusetts General Hospita, Harvard Medical School, Boston 02114, USA. morris@hadron.mgh.harvard.edu
PURPOSE: Based on reports of greater toxicity from radiation therapy,
collagen vascular diseases (CVDs) have been considered a contraindication
to irradiation. We assessed the complications of radiation therapy in
patients with CVD. PATIENTS AND METHODS: A total of 209 patients with
documented CVD were irradiated between 1960 and 1995. One hundred
thirty-one had rheumatoid arthritis (RA), 25 had systemic lupus
erythematosus (SLE); 17 had polymyositis or dermatomyositis; 16 had
scleroderma; eight had ankylosing spondylitis; five had juvenile RA; three
had discoid lupus erythematosus; and four had 4 mixed connective tissue
disorders (MCTD). The mean follow-up duration of curative cases was more
than 6 years. Doses ranged from 10 to 87.6 Gy, with a median of 45 Gy.
RESULTS: Overall, 263 sites were assessable in 209 patients. Significant
(> or = grade 3) acute toxicity was seen in 10% of irradiated sites.
Severe late effects were associated with significant acute reactions and
with non-RA CVDs (6% v 21% at 5 years). No difference was seen in late
effects according to timing of CVD onset, presence of concurrent vascular
insults, radiation dose, or other technical factors, or by measures of
disease activity. CONCLUSION: RA does not appear to have an elevated rate
of late toxicity. While non-RA CVD is significantly associated with
increased radiation late effects at standard doses, radiation-related
mortality remains exceedingly rare. The choice of therapeutic modality in
this radiosensitive group of patients should be made on a case-by-case
basis.
