Radiotherapy in advanced glottic laryngeal carcinoma in a patient with Wegener’s granulomatosis: how much radiation dose is needed?
Received 31 July 2018
Accepted for publication 23 November 2018
Published 23 January 2019 Volume 2019:12 Pages 753—757
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Takuya Aoki
Grazia Lazzari,1 Alessandra Briatico Vangosa,2 Maria Assunta De Cillis,3 Giovanni Silvano1
1Radiation Oncology Unit, San Giuseppe Moscati Hospital, Taranto, Italy; 2Department of Radiology, San Giuseppe Moscati Hospital, Taranto, Italy; 3Otorinolaringoiatry Unit, San Giuseppe Moscati Hospital, Taranto, Italy
Abstract: Wegener’s granulomatosis (WG) is an autoimmune disorder characterized by necrotizing granulomas involving mainly the upper–lower respiratory and renal tracts, albeit a potentially life-threatening involvement of other body parts is not rare. Furthermore, there are several reports accounting for an increased risk of solid malignancies due to the autoimmune disease per se, or the immunosuppressive therapies. Among treatments, radiotherapy could be a therapeutic option as proven by its use in typical WG lesions such as solitary granulomas or subglottic stenosis, successfully treated with low radiation dose. Herein, we report a case of squamous cell carcinoma of the glottis–subglottic larynx, T3 N0 M0 stage, occurring in a patient with a long-standing WG, heavily treated in the past with cyclophosphamide and rituximab, who achieved a complete response of the tumor using a low-dose radiation therapy and no concurrent chemotherapy. The hypothesis is that this cancer probably arose from a subglottic stenosis as a late manifestation of WG and exhibited more radiosensitivity than a naïve tumor. If so, solid tumors occurring on granulomas within an autoimmune disease course should be treated with a lower radiation dose.
Keywords: Wegener’s granulomatosis, ANCA-associated vasculitis, squamous cell carcinoma, cyclophosphamide, rituximab
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