Lin Alexander, Abu-Isa Eyad, Griffith Kent A, Ben-Josef Edgar
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
Cancer. 2008 Aug 1;113(3):648-53. doi: 10.1002/cncr.23591.
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.
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).
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.
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.
胶原血管病（CVD）的诊断可能使患者更易发生放疗（RT）毒性反应。本研究的目的是确定在CVD患者中影响RT毒性反应的因素。
1985年至2005年间，共为73例CVD患者进行了86个疗程的放疗。CVD亚型包括类风湿关节炎（RA；33例患者）、系统性红斑狼疮（SLE；13例患者）、硬皮病（9例患者）、皮肌炎/多肌炎（5例患者）、强直性脊柱炎（4例患者）、风湿性多肌痛/颞动脉炎（4例患者）、韦格纳肉芽肿病（3例患者）以及混合性结缔组织病（MCTD）/其他（2例患者）。每例CVD患者均按照性别、种族、照射部位、放疗剂量（±2 Gy）和年龄（±5岁）与1至3名对照者进行匹配。
发生任何急性毒性反应的CVD患者（65.1%）与对照者（72.5%）之间无显著差异。CVD患者发生任何晚期毒性反应的发生率更高（29.1%对14%；P = 0.001），且严重晚期毒性反应发生率有增加趋势（9.3%对3.7%；P = 0.079）。对乳腺进行放疗会增加严重急性毒性反应的风险，而对骨盆进行放疗会增加严重急性和晚期毒性反应的风险。在硬皮病患者中进行放疗会有更高的严重晚期毒性反应风险，而对SLE患者进行放疗会有更高的严重急性和晚期毒性反应风险。
尽管放疗通常耐受性良好，但在CVD患者中进行放疗似乎有更高的晚期毒性反应风险。对骨盆进行放疗或在SLE或硬皮病患者中进行放疗可能会有更高的严重毒性反应风险。在决定是否为这些患者提供放疗时应考虑这些问题。
