Background/Purpose:

Radiation oncologists are hesitant to treat scleroderma (SSc) patients with cancer due to concerns about triggering exaggerated fibrosis. In this study, we examined SSc patients with breast cancer to 1) identify the prevalence of radiation complications and 2) examine whether SSc and cancer outcomes differed between SSc patients who received or did not receive radiation therapy (RT) as part of their cancer treatment regimen.

Methods:

Patients with SSc and breast cancer were identified from the Johns Hopkins Scleroderma Center database. Demographics, SSc phenotypic data, cancer treatments and RT outcomes were abstracted from the database and medical record review. Among women exposed to RT, we examined whether erythema, blistering, ulceration, or thickening of the skin developed in the RT port. The following outcomes were compared between patients who did and did not receive RT: 1) changes in mRSS and FVC at 2 years post cancer diagnosis by the Student’s t test and 2) percentage of patients cancer free at 1, 2 and 5 years by a chi square test.

Results:

116 female SSc patients with a breast cancer diagnosis were identified. Most patients had limited disease (65.4% vs. 34.6% diffuse) and were white (90.5%). The mean age at SSc onset and cancer diagnosis was 53.4±12.2 and 55.7±10.6 years, respectively. 43 women (37.1%) received RT as part of their cancer treatment regimen: 4/31 with available data developed erythema, 0/31 had blistering, 1/31 developed ulceration, and 16/33 had skin thickening in the RT port. There was not a statistically significant association between skin thickening in the RT port and cutaneous subtype (OR 1.89 for diffuse vs. limited, 95% CI 0.44, 7.85). 3/30 patients with available data developed pulmonary fibrosis that was restricted to the lung fields in the radiation port. While 48.5% of women treated with RT developed localized cutaneous fibrosis, patients treated with RT required less extensive surgery for their breast cancers (66% with lumpectomy in RT group vs 34% in no RT group, p<0.001). When comparing patients with and without exposure to RT, there were no statistically significant differences in change in mRSS (mean change 0.6 in RT group (N=5) vs. 0.26 in no RT group (N=19), p= 0.32) or change in FVC at 2 years (mean change 5.6% in RT group (N=6) vs. -1.8% in no RT group (N=24), p= 0.15). There were no statistically significant differences in the proportion of patients who were cancer free 1, 2, and 5 years post breast cancer diagnosis in patients who received RT versus those who did not. Similarly, there were no significant differences in mortality (34.3% no RT, 34.9% RT).

Conclusion:

While <50% SSc patients with breast cancer developed localized radiation induced cutaneous fibrosis, patients treated with RT were able to avoid more extensive surgery. Cutaneous subtype was not associated with the risk of developing localized radiation fibrosis. While our sample size was limited, SSc and cancer outcomes were similar between the two groups, suggesting that exposure to RT did not exacerbate SSc. These data suggest that among SSc patients with breast cancer, the decision about whether or not to proceed with RT should be an individualized decision based on patient preferences.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/examining-the-impact-of-radiation-therapy-on-scleroderma-and-cancer-outcomes-in-scleroderma-patients-with-breast-cancer/