Collagen vascular diseases and radiation therapy: a critical review

PURPOSE Based on reports of greater toxicity from radiation therapy, collagen vascular diseases (CVDs) have been considered a contraindication to irradiation. We assessed the complications of radiation therapy in patients with CVD. PATIENTS AND METHODS A total of 209 patients with documented CVD were irradiated between 1960 and 1995. One hundred thirty-one had rheumatoid arthritis (RA), 25 had systemic lupus erythematosus (SLE); 17 had polymyositis or dermatomyositis; 16 had scleroderma; eight had ankylosing spondylitis; five had juvenile RA; three had discoid lupus erythematosus; and four had 4 mixed connective tissue disorders (MCTD). The mean follow-up duration of curative cases was more than 6 years. Doses ranged from 10 to 87.6 Gy, with a median of 45 Gy. RESULTS Overall, 263 sites were assessable in 209 patients. Significant (> or = grade 3) acute toxicity was seen in 10% of irradiated sites. Severe late effects were associated with significant acute reactions and with non-RA CVDs (6% v 21% at 5 years). No difference was seen in late effects according to timing of CVD onset, presence of concurrent vascular insults, radiation dose, or other technical factors, or by measures of disease activity. CONCLUSION RA does not appear to have an elevated rate of late toxicity. While non-RA CVD is significantly associated with increased radiation late effects at standard doses, radiation-related mortality remains exceedingly rare. The choice of therapeutic modality in this radiosensitive group of patients should be made on a case-by-case basis.

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Acute and late reactions to radiation therapy in patients with collagen vascular diseases

Cancer ◽

10.1002/1097-0142(19930601)71:11<3744::aid-cncr2820711144>3.0.co;2-c ◽

1993 ◽

Vol 71 (11) ◽

pp. 3744-3752 ◽

Cited By ~ 104

Author(s):

Joseph G. Ross ◽

David H. Hussey ◽

Nina A. Mayr ◽

Charles S. Davis

Keyword(s):

Radiation Therapy ◽

Vascular Diseases ◽

Collagen Vascular Diseases

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Matched-Control Retrospective Study of the Acute and Late Complications in Patients with Collagen Vascular Diseases Treated with Radiation Therapy

The Cancer Journal ◽

10.1097/00130404-200311000-00005 ◽

2003 ◽

Vol 9 (6) ◽

pp. 461-466 ◽

Cited By ~ 51

Author(s):

Cuong Phan ◽

Michael Mindrum ◽

Craig Silverman ◽

Kristie Paris ◽

William Spanos

Keyword(s):

Radiation Therapy ◽

Retrospective Study ◽

Matched Control ◽

Vascular Diseases ◽

Late Complications ◽

Collagen Vascular Diseases

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Relationship Between Fibrinopeptide A and Fibrinogen/Fibrin Fragment E in Thromboembolism, DIC and Various Non-Thromboembolic Diseases

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645965 ◽

1987 ◽

Vol 58 (02) ◽

pp. 758-763 ◽

Cited By ~ 11

Author(s):

G Mombelli ◽

R Monotti ◽

A Haeberli ◽

P W Straub

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Liver Cirrhosis ◽

Healthy Subjects ◽

Vascular Diseases ◽

Fibrinopeptide A ◽

Normal Range ◽

Collagen Vascular Diseases ◽

Intravascular Coagulation ◽

Fibrin Formation

SummaryIncreased fibrinopeptide A (FPA) levels have been reported in various non-thrombotic disorders, including cancer, acute myocardial infarction, liver cirrhosis and collagen vascular diseases. To investigate the significance of these findings, the present study combined the radioimmunoassay of FPA with that of fibrinogen/fibrin degradation fragment E (FgE) in the aforementioned disorders and compared the results with those observed in healthy subjects as well as in patients with thromboembolism and overt disseminated intravascular coagulation (DIC). Mean FPA and FgE in malignancy were 6.3 and 305 ng/ml, in myocardial infarction 5.6 and 98 ng/ml, in liver cirrhosis 2.7 and 132 ng/ml and in collagen vascular diseases 5.6 and 142 ng/ml. All these values were significantly higher than in healthy controls (mean FPA 1.6 ng/ml, mean FgE 49 ng/ml) but significantly lower than in thromboembolism (mean FPA 10.7 ng/ml, mean FgE 639 ng/ ml) and DIC (mean FPA 22.0 ng/ml, mean FgE 1041 ng/ml). The overall correlation between FPA and FgE was highly significant. Elowever, different disorders showed peculiar patterns in FPA, FgE and fibrinogen levels. In malignancy, a definite increase of FPA, FgE and plasma fibrinogen levels was observed. This finding probably indicates a compensated state of (intra- or extravascular) fibrin formation and lysis. Acute myocardial infarction was characterized by a high FPA to FgE ratio, which is interpreted to reflect acute thrombin generation and fibrin formation. FPA in cirrhosis was only marginally elevated with most single values within the normal range, indicating that intravascular coagulation was infrequent and unimportant in quantitative terms.

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