Contraindications to Radiation Therapy
Collagen vascular diseases
It is a commonly held notion that collagen vascular diseases--such as lupus, scleroderma, Sjogren's, etc.--are an absolute contraindication to radiotherapy since the effects on normal tissue would be greater, and even severe.
Collagen vascular diseases include: rheumatoid arthritis, scleroderma, Raynaud's, lupus erythematosus, Sjogren's, polymyositis.
Several studies, however, claim that it is safe to give high dose radiation in these patients:
- Review; 2007 PMID 18035210 -- "Radiotherapy in setting of collagen vascular disease." (Wo J, Int J Radiat Oncol Biol Phys. 2007 Dec 1;69(5):1347-53.)
- Published results remain controversial
- Close involvement of rheumatologists. Consider initiating NSAID prior to treatment
- Yale; 2001 PMID 11769860 — "Breast-conserving therapy in the setting of collagen vascular disease." (Chen AM, Cancer J. 2001 Nov-Dec;7(6):480-91.)
- 36 pts (17-RA, 4-SD, 4-Raynaud, 5-Lupus, 2-Sjogren, 4-polymyositis). Median total dose 64 Gy.
- Matched to control patients. Median f/u 12.5 yrs. No significant difference in acute complications (14% vs 8%). A significant difference was noted for late complications (17% vs 3%). When analyzed by specific disease, the difference disappeared in all but the scleroderma group.
- Conclusion:Higher incidence of complications for scleroderma but not other collagen vascular diseases.
- U.Pittsburgh; 1998 PMID 9499258 — "Radiotherapy for malignancies associated with lupus: case reports of acute and late reactions." (Rakfal SM, Am J Clin Oncol. 1998 Feb;21(1):54-7.)
- 6 pts with Lupus (5-SLE, 1-discoid) treated with RT (4-breast, 1-Hodgkin's, 1-thymoma). With f/u of 7-121 months, none of the patients had severe acute or late skin or subcutaneous complications.
- Conclusion: No severe acute or late reactions in patients with Lupus after radiotherapy
- Iowa; 1993 PMID 8490925 -- "Acute and late reactions to radiation therapy in patients with collagen vascular diseases." (Ross JG, Cancer. 1993 Jun 1;71(11):3744-52.)
- 61 pts with CVD (39-RA, 13-Lupus, 4-scleroderma, 4-dermatomyositis, 1-polymyositis). Matched to control patients.
- No significant difference in acute (11% vs 7%) or late (10% vs 7%) complications. 3 pts with CVD had fatal complications vs none in the control group. RA was associated with a slight increase in late complications; SLE was associated with a slight increase in acute reactions. No significant acute or late reactions were noted in patients with scleroderma, dermato- or poly-myositis.
- Conclusion: there was no increase in complications for patients with CVD
Inherited Hypersensitivity Syndromes
- Some patients with these syndromes may exhibit abnormally severe normal tissue reactions
- Ataxia-Telangiectasia is the most striking example
- RT doses may need to be adjusted accordingly