Johns Hopkins University School of Medicine, Baltimore, Maryland.
Georgetown University School of Medicine, Washington, DC.
Arthritis Care Res (Hoboken). 2018 Oct;70(10):1517-1524. doi: 10.1002/acr.23505.
We examined systemic sclerosis (SSc) patients with breast cancer to identify the prevalence of radiation complications and to examine outcomes in SSc patients who received radiation therapy as part of their cancer treatment.
Patients with SSc and breast cancer were identified from the Johns Hopkins and University of Pittsburgh Scleroderma Center databases. We examined whether erythema, blistering, ulceration, or thickening of the skin developed in the radiation therapy port. Changes in modified Rodnan skin thickness score (mRSS) and forced vital capacity percent predicted (FVC%) at 12 and 24 months post-cancer diagnosis were compared between patients who did and those who did not receive radiation therapy.
A total of 43 of 116 breast cancer patients at Johns Hopkins and 26 of 37 patients at the University of Pittsburgh received breast radiation therapy. At Johns Hopkins, 4 of 30 (13.3%) patients with available data developed erythema, none had blistering, 1 of 30 (3.3%) developed ulceration, and 15 of 31 (48.4%) had skin thickening in the radiation port. At the University of Pittsburgh, 7 of 11 patients (63.6%) with available data developed erythema, 2 of 11 (18.2%) had blistering, none developed ulceration, and 6 of 11 (54.6%) had skin thickening in the radiation port. In a limited sample, there were no significant changes in the mRSS or FVC% between patients who did and those who did not receive radiation therapy.
These data suggest that radiation injury causing local tissue fibrosis is not inevitable in SSc patients with breast cancer, occurring in approximately 50% of patients without evidence of lung or generalized skin disease flare. Therefore, the use of radiation therapy for breast cancer is considered an option based on the informed patient's preference.
我们研究了患有乳腺癌的系统性硬化症 (SSc) 患者，以确定辐射并发症的发生率，并检查在癌症治疗中接受放射治疗的 SSc 患者的治疗结果。
从约翰霍普金斯大学和匹兹堡大学硬皮病中心数据库中确定了患有 SSc 和乳腺癌的患者。我们检查了放射治疗端口处是否出现皮肤红斑、水疱、溃疡或增厚。比较了癌症诊断后 12 个月和 24 个月时接受和未接受放射治疗的患者的改良罗德南皮肤厚度评分 (mRSS) 和用力肺活量百分比预测值 (FVC%) 的变化。
约翰霍普金斯大学的 116 名乳腺癌患者中有 43 名和匹兹堡大学的 37 名患者中有 26 名接受了乳房放射治疗。在约翰霍普金斯大学，30 名患者中有 4 名（13.3%）出现红斑，无水疱，30 名患者中有 1 名（3.3%）出现溃疡，31 名患者中有 15 名（48.4%）出现放射治疗端口处皮肤增厚。在匹兹堡大学，11 名患者中有 7 名（63.6%）出现红斑，11 名患者中有 2 名（18.2%）出现水疱，无溃疡，11 名患者中有 6 名（54.6%）出现放射治疗端口处皮肤增厚。在一个有限的样本中，接受和未接受放射治疗的患者之间的 mRSS 或 FVC% 没有显著变化。
这些数据表明，在患有乳腺癌的 SSc 患者中，辐射引起的局部组织纤维化损伤并非不可避免，大约 50%的患者没有肺部或全身性皮肤疾病发作的证据。因此，基于知情患者的偏好，考虑使用放射治疗乳腺癌是一种选择。
