title: Pelvic radiotherapy in the setting of rheumatoid arthritis: Refining the paradigm.
abstract: OBJECTIVE
  Conflicting results concerning the toxicity of radiotherapy in the setting of rheumatoid arthritis were reported in literature. This work describes the toxicity profiles of patients with rheumatoid arthritis undergoing pelvic radiotherapy for gynecologic malignancies at our institution.
  
  
  METHODS
  Charts of patients with rheumatoid arthritis who underwent pelvic radiotherapy for cervical or endometrial cancer in a curative intent at the Gustave-Roussy Cancer Campus between 1990 and 2015 were reviewed for treatment-related toxicities. Acute and late effects were graded as per the Common Terminology Criteria for Adverse Events version 4.0 scoring system.
  
  
  RESULTS
  Eight patients with cervical cancer and three with endometrial cancer were identified. Median follow-up was 56 months. Median external beam radiotherapy dose was 45Gy. All patients received a brachytherapy boost using either pulse- or low-dose rate technique. Concomitant chemotherapy was used in seven cases. Median time from rheumatoid arthritis diagnosis to external beam radiation therapy was 5 years. No severe acute gastrointestinal or genitourinary toxicity was reported. One patient had grade 3 dermatitis. Any late toxicity occurred in 7 /11 patients, and one patient experienced severe late toxicities. One patient with overt systemic rheumatoid arthritis symptoms at the time of external beam radiation therapy experienced late grade 3 ureteral stenosis, enterocolitis and lumbar myelitis.
  
  
  CONCLUSIONS
  Pelvic radiotherapy, in the setting of rheumatoid arthritis, appears to be feasible, with potentially slight increase in low grade late events compared to other anatomic sites. Patients with overt systemic rheumatoid arthritis manifestation at the time of radiotherapy might be at risk of potential severe toxicities.
authors.affiliation: Service de curiethérapie, département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: T
authors.initials: T
authors.lastname: Felefly
authors.affiliation: Service de curiethérapie, département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: R
authors.initials: R
authors.lastname: Mazeron
authors.affiliation: Service de curiethérapie, département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Huertas
authors.affiliation: Service de curiethérapie, département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: C H
authors.initials: CH
authors.lastname: Canova
authors.affiliation: Service de curiethérapie, département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: P
authors.initials: P
authors.lastname: Maroun
authors.affiliation: Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Kordahi
authors.affiliation: Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Département de chirurgie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: P
authors.initials: P
authors.lastname: Morice
authors.affiliation: Service de curiethérapie, département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: É
authors.initials: É
authors.lastname: Deutsch
authors.affiliation: Service de curiethérapie, département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: C
authors.initials: C
authors.lastname: Haie-Méder
authors.affiliation: Service de curiethérapie, département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Institut de recherche biomédicale des armées, BP 73, 91223 Brétigny-sur-Orge cedex, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France. Electronic address: cyrus.chargari@gustaveroussy.fr.
authors.forename: C
authors.initials: C
authors.lastname: Chargari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications*; D016889:Endometrial Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010388:Pelvis / Q000528:radiation effects; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000532:radiotherapy*
keywords: Cancers gynécologiques; Gynecologic malignancies; Pelvis; Polyarthrite rhumatoïde; Radiotherapy; Radiothérapie; Rheumatoid arthritis; Toxicity; Toxicité