Table 5.
Literature review of patients with scleroderma and breast cancer who received radiation therapy to the breast/chest wall
| First Author | Year | Number with SSc, breast cancer and local irradiation | Type of radiation therapy | Complications |
|---|---|---|---|---|
| Ransom (7) | 1987 | 1 | External beam; conventional fractionation | Marked late fibrosis, breast shrinkage |
| Fleck (8) | 1989 | 1 | External beam; conventional fractionation | Acute moist desquamation; late fibrosis, telangiectasias, and necrosis requiring surgical intervention; late pulmonary fibrosis |
| Matthews (9) | 1989 | 1 | External beam; conventional fractionation | Late fibrosis and telangiectasias |
| Robertson (10) | 1991 | 1 | External beam; conventional fractionation | Edema, with marked retraction and fibrosis of the breast; rib fractures; late development of limitation in left arm range of motion due to pectoralis muscle fibrosis |
| Varga (11) | 1991 | 2 | External beam; conventional fractionation to breast and hypofractionation to hip for metastatic lesion | New onset SSc developed 2 months after completion of radiation therapy in 1st patient. Edema, induration and thickening on ipsilateral arm and trunk in 2nd patient. |
| Morris (12) | 1997 | 1 | External beam; conventional fractionation | No acute toxicity; Painful fibrosis, cool arm as late effects |
| Chen (13) | 2001 | 4 | External beam; conventional fractionation | 1st patient: moist desquamation and pitting edema initially; later fibrosis, ulceration and progressive flap necrosis after mastectomy done 2nd patient: minimal erythema and grade II moist desquamation; later decrease in left shoulder and arm range of motion associated with marked fibrosis, small ulceration and subsequent necrosis 3rd patient: mild dry desquamation; later transient left vocal cord paralysis; progressive fibrosis and telangiectasia of breast over 5 year period followed by stabilization 4th patient: none |
| Gold (19) | 2007 | 1 | External beam; conventional fractionation | Acute grade 2 skin toxicity (brisk erythema with or without limited moist desquamation); Late toxicity - telangiectasia and hyperpigmentation of skin in radiation field and incidentally noted pulmonary fibrosis |
| Kounalakis (20) | 2011 | 1 (bilateral breast cancers) | Accelerated (PBI) partial breast irradiation brachytherapy | Transient erythema; mild induration and telangiectasias along incisions on both breasts |
| Dragun (21) | 2011 | 1 | Accelerated (PBI) partial breast irradiation brachytherapy | Outcomes specific to SSc unclear but no severe outcomes noted in CVD patients |
| Kyrgias (22) | 2012 | 4 | External beam; conventional fractionation | Acute skin toxicity grade 1 (mild erythema): 2 pts, grade 2 (brisk erythema with or without limited moist desquamation): 1 pt, grade 3 (extensive moist desquamation beyond skin folds): 1 pt. Late toxicity: grade 1 (slight atrophy) – two patients (after a follow-up of 12 and 127 months); grade 2 (moderate atrophy) – in one patient (after a follow-up of 155 months). One patient developed grade 1 lung toxicity (radiographic changes without symptoms). |