Scleroderma and Breast Cancer: Examining Outcomes of Radiation Therapy

Radiation injury causing localized tissue fibrosis occurred in approximately half of all patients with systemic scleroderma (SSc) who are diagnosed with breast cancer, with no evidence of lung or generalized skin disease flare, according to the results of a retrospective study published in Arthritis Care & Research.

Researchers from Johns Hopkins University and the University of Pittsburgh examined patients with SSc and concurrent breast cancer to identify the prevalence of radiation complications in this population, examining outcomes among patients who received radiation therapy as part of their cancer treatment.

Individuals with SSc and breast cancer were identified from the Johns Hopkins University and University of Pittsburgh Scleroderma Center databases. The researchers examined whether erythema, blistering, ulceration, or thickening of the skin occurred at the radiation therapy port. Changes in modified Rodman skin score (mRSS) and forced vital capacity (FVC) at 12 and 24 months following a cancer diagnosis were compared between patients receiving and not receiving radiation therapy.

Overall, 43 of 116 patients at Johns Hopkins University and 26 of 37 patients at University of Pittsburgh were treated with breast radiation therapy. At Johns Hopkins University, erythema developed in 13.3% of those with available data, none reported blistering, ulceration occurred in 3.3%, and 48.4% had skin thickening at the radiation therapy port. In contrast, at the University of Pittsburgh, 63.6% of those with available data experienced erythema, 18.2% had blistering, none had ulceration, and 54.6% reported skin thickening at the radiation therapy port. No significant changes in mRSS or FVC were observed between patients who did or did not receive radiation therapy.

The investigators concluded that patients with SSc who are diagnosed with breast cancer should receive counseling about the estimated risks associated with localized radiation-induced fibrosis. The decision regarding whether to proceed with radiation therapy in this population should involve a multidisciplinary discussion with the treating rheumatologist, the medical and radiation oncologists, the breast surgeon, and the patient, to consider the patient’s personal preferences and tolerance

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Reference

Shah DJ, Hirpara R, Poelman CL, et al. Impact of radiation therapy on scleroderma and cancer outcomes in scleroderma patients with breast cancer [published online January 5, 2018].  Arthritis Care Res (Hoboken). doi:10.1002/acr.23505