Ni Lisa, Phuong Christina, Yom Sue S, Chan Jason W
Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, Seattle, WA, USA.
J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251379333. doi: 10.1177/19160216251379333. Epub 2025 Sep 25.
ImportanceLimited evidence exists to guide the safe use of radiotherapy (RT) and concurrent disease-modifying antirheumatic drugs (DMARDs) in patients with collagen vascular disease (CVD).ObjectiveTo describe toxicity outcomes in patients with CVD receiving intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC) and to evaluate whether concurrent DMARD use is associated with increased toxicity.DesignRetrospective cohort study.SettingSingle academic tertiary care center in the United States, from 2005 to 2022.ParticipantsTwenty-three adult patients with CVD [eg, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), dermatomyositis (DM)] and biopsy-proven HNC treated with curative-intent IMRT. Eligibility required available treatment records and ≥90 days of follow-up post-RT.Intervention or ExposuresDefinitive or postoperative IMRT for HNC. Exposure of interest was concurrent use of DMARDs during RT.Main Outcome MeasuresRates of acute (≤90 days) and late (>90 days) grade ≥2 and ≥3 toxicities, as graded by CTCAE v5.0. Fisher exact tests were used to compare toxicity rates by DMARD use.ResultsMedian follow-up was 56 months (IQR 9-98). Most common CVDs were RA (39%), SLE (17%), and DM (17%). Median RT dose was 66 Gy (range 48-70 Gy); 39% received concurrent chemotherapy. Acute grade ≥3 toxicity occurred in 35% (n = 8) and late grade ≥3 in 13% (n = 3). No grade ≥4 toxicities were observed. DMARD use during RT was not associated with higher rates of acute or late grade ≥2 or ≥3 toxicity ( > .1 for all comparisons).ConclusionsIMRT was associated with moderate rates of severe toxicity in patients with CVD, but DMARD use during RT did not increase risk.RelevanceConcurrent DMARDs may be safely continued during IMRT for HNC in patients with CVD. Prospective studies are needed to confirm these findings and refine risk stratification by CVD subtype and treatment regimen.
重要性
关于在胶原血管病（CVD）患者中安全使用放疗（RT）和同时使用改善病情抗风湿药物（DMARDs）的证据有限。
目的
描述接受调强放疗（IMRT）治疗头颈癌（HNC）的CVD患者的毒性结果，并评估同时使用DMARDs是否与毒性增加相关。
设计
回顾性队列研究。
地点
美国一家学术性三级医疗中心，时间为2005年至2022年。
参与者
23例患有CVD[如类风湿关节炎（RA）、系统性红斑狼疮（SLE）、皮肌炎（DM）]且经活检证实为HNC并接受根治性IMRT治疗的成年患者。入选标准要求有可用的治疗记录且放疗后随访≥90天。
干预或暴露
针对HNC的确定性或术后IMRT。感兴趣的暴露因素是放疗期间同时使用DMARDs。
主要结局指标
根据CTCAE v5.0分级的急性（≤90天）和晚期（>90天）≥2级和≥3级毒性发生率。采用Fisher精确检验比较使用DMARDs与否的毒性发生率。
结果
中位随访时间为56个月（四分位间距9 - 98个月）。最常见的CVD为RA（39%）、SLE（17%）和DM（17%）。中位放疗剂量为66 Gy（范围48 - 70 Gy）；39%的患者接受了同步化疗。急性≥3级毒性发生率为35%（n = 8），晚期≥3级为13%（n = 3）。未观察到≥4级毒性。放疗期间使用DMARDs与急性或晚期≥2级或≥3级毒性发生率较高无关（所有比较P>0.1）。
结论
IMRT在CVD患者中与中度严重毒性发生率相关，但放疗期间使用DMARDs并未增加风险。
相关性
在CVD患者接受HNC的IMRT治疗期间，可安全继续同时使用DMARDs。需要前瞻性研究来证实这些发现，并根据CVD亚型和治疗方案完善风险分层。
