Radiotherapy of early breast cancer in scleroderma patients: our experience with four cases and a short review of the literature

George Kyrgias^1,2, Kiki Theodorou^3,4, Anna Zygogianni¹, Konstantinos Tsanadis², Stefanos Zervoudis⁵, John Tzitzikas⁶, Michael Koukourakis^7
1Academic Radiotherapy, University of Thessaly, Medical School, Greece; ²Radiation Oncology Department, University Hospital of Larissa, Greece; ³Academic Medical Physics, University of Thessaly, Medical School, Greece; ⁴Medical Physics Department, University Hospital of Larissa, ⁵Breast Unit, REA Hospital, Athens, Greece; ⁶Radiation Oncology Department, AHEPA University Hospital of Thessaloniki, Greece; ⁷Radiotherapy-Oncology Department, University Hospital of Alexandroupolis, Greece

Purpose: Connective vascular diseases (CVD), including scleroderma, are reported to represent for some researchers a relative contraindication and for others absolute contraindication for radiotherapy. The purpose of our study is to add four new cases to the existing body of international literature and to determine whether women with pre-existing scleroderma who have been surgically treated for early breast cancer could undergo postsurgical radiotherapy without serious early and late complications.
Patients and methods: From May 1998 to November 2010, we irradiated for early breast cancer four patients suffering from pre-existing scleroderma; after conservative surgery, we performed whole breast postoperative radiotherapy of 50.4 Gy total dose to the whole breast plus a 9 Gy boost to the tumor bed. We reviewed the records of all four patients and evaluated the early and late reactions using acute radiation morbidity scoring criteria (Radiation Therapy Oncology Group [RTOG], American College of Radiology, Philadelphia, PA) and late radiation morbidity scoring scheme (European Organisation for Research and Treatment of Cancer [EORTC], Brussels, Belgium and RTOG).
Results: After a median follow-up of 105 months (range 12–155 months) the early and late toxicity concerning the skin, the subcutaneous tissues, the lungs, and the heart have been acceptable and are in full accordance with what have been reported in international literature.
Conclusion: This study matches global experience, which shows that patients with scleroderma and breast cancer must be discussed by the multidisciplinary tumor board in order for a personalized treatment strategy to be formulated. Radiation therapy can be proposed as a postsurgical therapeutic option in selected cases.

Keywords: breast radiotherapy, early toxicity, late complications, short review, scleroderma