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. 2024 Sep-Oct;14(5):e334-e343.
doi: 10.1016/j.prro.2024.04.015. Epub 2024 May 3.

The Impact of Radiation Therapy in Patients with Systemic Sclerosis and Head and Neck Cancer

Rachel S Wallwork  1 , Brandi R Page  2 , Fredrick M Wigley  1 , Laura K Hummers  1 , Julie J Paik  1 , Zsuzsanna McMahan  1 , Robyn T Domsic  3 , Ami A Shah  4
Affiliations

The Impact of Radiation Therapy in Patients with Systemic Sclerosis and Head and Neck Cancer

Rachel S Wallwork et al. Pract Radiat Oncol. 2024 Sep-Oct.

Abstract

Objective: Systemic sclerosis (SSc) is considered a relative, or in some cases, absolute contraindication for radiation therapy for various cancers; however, radiation is the standard of care and the best option for tumor control for locally advanced head and neck (H&N) cancer. We present a case series to document postradiation outcomes in patients with SSc and H&N cancer.

Methods: Patients with SSc and H&N cancer treated with radiation were identified from the Johns Hopkins Scleroderma Center and the University of Pittsburgh Scleroderma Center research registries. Through chart review, we identified whether patients developed predetermined acute and late side effects or changes in SSc activity from radiation. We further describe therapies used to prevent and treat radiation-induced fibrosis.

Results: Thirteen patients with SSc who received radiation therapy for H&N cancer were included. Five-year survival was 54%. Nine patients (69%) developed local radiation-induced skin thickening, and 7 (54%) developed reduced neck range of motion. Two patients required long-term percutaneous endoscopic gastrostomy use due to radiation therapy complications. No patients required respiratory support related to radiation therapy. Regarding SSc disease activity among the patients with established SSc before radiation therapy, none experienced interstitial lung disease progression in the postradiation period. After radiation, one patient had worsening skin disease outside the radiation field; however, this patient was within the first year of SSc, when progressive skin disease is expected. Treatment strategies to prevent radiation fibrosis included pentoxifylline, amifostine, and vitamin E, while intravenous immunoglobulin (IVIG) was used to treat it.

Conclusion: Although some patients with SSc who received radiation for H&N cancer developed localized skin thickening and reduced neck range of motion, systemic flares of SSc were uncommon. This observational study provides evidence to support the use of radiation therapy for H&N cancer in patients with SSc when radiation is the best treatment option.

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Conflict of interest statement

Disclosures Dr Domsic received consulting fees from Astra Zeneca and Aisa pharmaceuticals. Dr Shah received grant support for clinical trials from Kadmon Corporation, Arena Pharmaceuticals, Medpace LLC, and Eicos Sciences. Dr Paik receives royalties from UpToDate. Dr Hummers received grant support for clinical trials through Horizon Pharmaceuticals, Astra Zeneca, Merck, Glaxo Smith Kline, Kadmon Corporation, Cumberland Pharmaceuticals, Boehringer Ingelheim, and Mitsubishi Tanabe.

Figures

Figure 1.
Figure 1.
Radiation fibrosis in a patient with scleroderma and head and neck cancer
Figure 2.
Figure 2.
Radiation induced neck flexion contracture in a patient with scleroderma and head and neck cancer
See this image and copyright information in PMC

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