放疗对全身性硬化症和头颈部癌症患者的影响。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology Pub Date : 2024-09-01 DOI:10.1016/j.prro.2024.04.015

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引用次数: 0

摘要

目的：系统性硬化症（SSc）被认为是各种癌症放射治疗的相对禁忌症，在某些情况下甚至是绝对禁忌症；然而，放射治疗是局部晚期头颈部癌症（H&N）的标准治疗方法和控制肿瘤的最佳选择。我们提供了一个病例系列，记录了 SSc 和 H&N 癌症患者放疗后的疗效：方法：我们从两个大型硬皮病中心研究登记处找到了接受放射治疗的 SSc 和 H&N 癌症患者。通过病历审查，我们确定了患者是否因放射治疗而出现预先确定的急性和晚期副作用或 SSc 活性变化。我们进一步描述了用于预防和治疗辐射诱导的纤维化的疗法：共纳入了 13 名接受 H&N 癌症放射治疗的 SSc 患者。五年生存率为 54%。九名患者（69%）出现了局部放射引起的皮肤增厚，七名患者（54%）出现了颈部活动范围减小。两名患者因放疗并发症而需要长期使用经皮内镜胃造瘘术。没有患者因放疗而需要呼吸支持。关于放疗前已确诊的 SSc 患者的 SSc 疾病活动情况，没有人在放疗后出现间质性肺病进展。放射治疗后，一名患者在放射野外的皮肤病恶化，但这名患者是在 SSc 第一年内，皮肤病进展是意料之中的。预防放射性纤维化的治疗策略包括喷托维林、阿米福星和维生素E，而静脉注射免疫球蛋白（IVIG）则用于治疗放射性纤维化：虽然一些接受 H&N 癌症放射治疗的 SSc 患者会出现局部皮肤增厚和颈部活动范围减小的情况，但 SSc 全身性复发的情况并不常见。这项观察性研究为SSc患者使用放射治疗H&N癌提供了证据，如果放射治疗是最佳治疗方案的话。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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

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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来源期刊

Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

6.10%

发文量

177

审稿时长

34 days

期刊介绍： The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.