THE EFFECTS of radiotherapy on patients with systemic sclerosis (SSc) who develop cancer is a subject of growing concern due to the potential exacerbation of SSc symptoms and the risks of radiotherapy-related toxicity.
Authors Aos Aboabat et al., from Mount Sinai Hospital, Toronto Western Hospital in Ontario, Canada recently published a systematic review to evaluate the available evidence on effects of radiotherapy on SSc outcomes and radiotherapy-related toxicity.
Search terms “SSc” and “radiotherapy” were used in MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. Inclusion criteria were SSc diagnosis, subsequent cancer development, and radiotherapy exposure. Outcomes were SSc manifestations (cutaneous thickening, pulmonary fibrosis, and SSc flare) and radiotherapy toxicity (acute and late) using Common Terminology Criteria for Adverse Events for grading. Grade 1 and 2 toxicities were categorized as nonsevere and grade 3 to 5 toxicities as severe.
The review analyzed 121 patients, with an average age of 56.4 years, who underwent radiotherapy (median dose of 50 Gy). Most patients (74.5%) did not experience significant worsening of SSc-related skin thickening or pulmonary complications (74%) after radiotherapy treatment.
Acute side effects occurred in 57.3% of patients, with severe toxicities reported in 25.8%. Similarly, 32.4% experienced nonsevere late side effects, and 24% faced severe late-stage toxicities. These results highlight the variability in patient response to radiotherapy and suggest that, although the therapy may be a feasible option for patients with cancer and SSc, it requires careful monitoring due to the associated risks.
Despite these concerns, radiotherapy remains a crucial tool in cancer treatment, even for patients with autoimmune conditions like SSc. This review adds valuable insight into the balance between the benefits of cancer treatment and the risks of worsening SSc symptoms or experiencing severe adverse effects.
Reference: Aboabat A et al. Effects of radiotherapy for malignancy in systemic sclerosis: a systematic review. J Rheumatol. 2024;51(8):744-51.
Anaya Malik | AMJ
