Matched-control retrospective study of the acute and late complications in patients with collagen vascular diseases treated with radiation therapy.
BACKGROUND
Controversy surrounds the potential complication rate of patients with collagen vascular diseases (CVD) after radiation. We assess the acute and late complications (based on Radiation Therapy Oncology Group criteria) by a matched-control retrospective study. PATIRNTS/METHODS: The charts of 12,000 patients treated with radiation therapy at the University of Louisville from 1982 to 2001 were reviewed for CVD. A total of 38 patients with documented CVD were compared with a matched-control group of 38 patients without CVD. Median follow-up for patients with CVD was 35 months. The patients were matched on the basis of site treated, age, dose, date of treatment, sex, treatment goal, follow-up, tumor site and histology, therapeutic technique, and general treatment method. The patients with CVD included 21 patients with systemic lupus erythematosus (55%), two with scleroderma (5%), four with Raynaud's phenomena (11%), three with fibromyalgia (8%), three with polymyalgia rheumatica (8%), three with Sjögren's syndrome (8%), and two with polymyositis-dermatomyositis (5%). Twenty-nine patients received curative doses, and nine patients received palliative doses.


RESULTS
No difference was observed in the incidence of acute or late complications between the two groups. For CVD and matched-control patients receiving curative doses, the incidence of acute reaction for grade II was 49% versus 58% and for grade III was 7% versus 7%, respectively. The incidence of late reactions for patients with CVD and the matched control patients for grade I was 3% versus 7%, for grade II was 7% versus 3%, and for grade III was 7% versus 7%, respectively. The patients treated with palliation had a similar incidence of acute reaction in the CVD and the matched-control groups. No patients in the CVD or matched-control group had fatal complications. Only patients with scleroderma had a slight increase in acute and late complications.


CONCLUSIONS
This is the largest matched-control study thus far in the literature. In the comparison between the patients with CVD and the matched-control patients, there was no significant difference in the incidence of acute or late complication. However, there was a higher incidence of radiation complications in patients with scleroderma. Importantly, no fatal complication was noted in any of the patients with CVD.
Phan
Cuong
C
James Graham Brown Cancer Center/Radiation Oncology Department, University of Louisville, Kentucky, USA. chris.phan@louisville.edu
Mindrum
Michael
M
Silverman
Craig
C
Paris
Kristie
K
Spanos
William
W
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003095:Collagen Diseases / Q000532:radiotherapy*; D003882:Dermatomyositis / Q000532:radiotherapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005356:Fibromyalgia / Q000532:radiotherapy; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011111:Polymyalgia Rheumatica / Q000532:radiotherapy; D011832:Radiation Injuries / Q000209:etiology*; D011855:Radiodermatitis / Q000209:etiology; D011928:Raynaud Disease / Q000532:radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000532:radiotherapy; D012859:Sjogren's Syndrome / Q000532:radiotherapy; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology