title: Radiotherapy in patients with connective tissue diseases.
abstract: The decision to offer radiotherapy in patients with connective tissue diseases continues to be challenging. Radiotherapy might trigger the onset of connective tissue diseases by increasing the expression of self-antigens, diminishing regulatory T-cell activity, and activating effectors of innate immunity (dendritic cells) through Toll-like receptor-dependent mechanisms, all of which could potentially lead to breaks of immune tolerance. This potential risk has raised some debate among radiation oncologists about whether patients with connective tissue diseases can tolerate radiation as well as people without connective tissue diseases. Because the number of patients with cancer and connective tissue diseases needing radiotherapy will probably increase due to improvements in medical treatment and longer life expectancy, the issue of interactions between radiotherapy and connective tissue diseases needs to be clearer. In this Review, we discuss available data and evidence for patients with connective tissue diseases treated with radiotherapy.
authors.affiliation: Radiation Oncology Department, Sacro Cuore Hospital, Negrar-Verona, Italy. Electronic address: niccolo.giajlevra@sacrocuore.it.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Giaj-Levra
authors.affiliation: Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Torino, Italy, Turin, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Sciascia
authors.affiliation: Radiation Oncology Department, Sacro Cuore Hospital, Negrar-Verona, Italy.
authors.forename: Alba
authors.initials: A
authors.lastname: Fiorentino
authors.affiliation: Radiation Oncology Department, Sacro Cuore Hospital, Negrar-Verona, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Fersino
authors.affiliation: Radiation Oncology Department, Sacro Cuore Hospital, Negrar-Verona, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Mazzola
authors.affiliation: Radiation Oncology Department, Sacro Cuore Hospital, Negrar-Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ricchetti
authors.affiliation: Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Torino, Italy, Turin, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Roccatello
authors.affiliation: Radiation Oncology Department, Sacro Cuore Hospital, Negrar-Verona, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D003240:Connective Tissue Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy*; D061214:Patient Safety; D011379:Prognosis; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome