Irradiation in the setting of collagen vascular disease: Acute and late complications

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 held 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 (greater than or equal to 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. (C) 1997 by American Society of Clinical Oncology.