Radiotherapy for malignancies associated with chronic connective tissue diseases – review of the literature

Chronic connective tissue diseases are heterogenous group of disorders. There are some specific symptoms like inflammation of the skin, joints, muscles and other structures rich in connective tissue and immunological disturbances including production of antibodies and abnormalities of cell-mediated immunity. Previous reports have indicated that this subgroup of patients appears to present a contraindication for radiation therapy. Most of oncologists have the impression that patients with chronic connective tissue diseases tolerate radiotherapy less well than other patients because of a greater risk of severe radiation therapy complication. Publication found on this topics are short anecdotal case reports of patients with increased toxicity after radiation. This is mostly associated with such disorders like rheumatoid arthritis, systemic lupus erythematosus, discoid lupus erythemathosus, polymyositis, dermatomyositis, scleroderma and mixed connective tissue disorders.
Consequently, the true incidence of these side effects is unknown. Some authors stating that many patients do seem to show an enhanced radiation reaction, while others do not. Reducing the total dose and volume has been tried without success to minimize late radiation damage. Unless further studies on severe radiation effects in patients with chronic connective tissue diseases are reported, each patient should be advised of the possible increase risk of severe toxicity from radiation. These patient should be closely monitored during and after radiation treatment.