Radiotherapy in pts with connective tissue disorders & vitiligo

Radiotherapy in pts with connective tissue disorders & vitiligo

Dr Nilesh Mahale 07 Apr 2011 08:14

In our practice we encounter patients with connective tissue disorders & vitiligo in whome radiation is indicated by virtue of malignancy stage.
We all have read in text books that they tolerate RT poorly
Given the oncological compulsions to irradiate them what are experiences of the member of this forum?

Re: Radiotherapy in pts with connective tissue disorders & vitiligo

Santam Chakraborty 07 Apr 2011 13:25

Hi Nilesh, CTD yes but vitiligo? I have never seen issues with Vitiligo. As far as CTDs are concerned Scleroderma is the one to watch out for.

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Re: Radiotherapy in pts with connective tissue disorders & vitiligo

Nikhilesh Patil 07 Apr 2011 16:45

Vitiligo is not an issue, I dont recall any case where we had problems.
I recently had a post op Endometrial cancer patient with Scleroderma, we explained the risks and started treating her, within a week we had to abort. She was not able to tolerate. I was told the patient is sick, a lot of fatigue and generalized symptoms rather than anything specific. Patient did not show up, I wanted to see what exactly happened but then she never back to the cancer centre. I think if there is a case you should discuss and give it a shot, you never know who will tolerate.

Re: Radiotherapy in pts with connective tissue disorders & vitiligo

Dr Nilesh Mahale 08 Apr 2011 06:20

I have treated one 65 yrs old man with Ca alveolus & Buccal Mucosa (pT4pN2b) and Psoriasis. He could take RT upto 50 Gy hasn't come for follow up. Had severe reations.
At present I have a 35 yr old man with huge lt leg squamus ca post op with psoriasis. He has finished 40 Gy tolerting well but new psoriatic lesions have appeared in and out of field. I am concerned if I should continue. I have already explained possibility of higher reactions to his medico bro in law.
Another 65 yrs old man with Ca Soft palate is also on treatment. He has vitiligo affecting most of body surface. He has finished 14 Gy and has relatively early appearance of skin and mucosal reactions.

So a bunch of cases. We have to give RT in the given oncological context. I think we need to know how to devise customised plans

Re: Radiotherapy in pts with connective tissue disorders & vitiligo

Santam Chakraborty 08 Apr 2011 08:30

As far as the psoriasis is concerned its most likely a stress reaction and if the patient is tolerating well its best that a derma chap sees .. he probably needs some topical steroids in areas away from the RT field.
I would not be drawing conclusions about tolerance from a T4 buccal mucosa .. most likely he had a large vol of oral mucosa irradiated. That said there are some conditions that can increase the skin sensitivity to RT most notably AT. Also an autoimmune exacerbation is not a unseen phenomenon during RT .. for example I have 2 patients developing steven jhonson syndrome after starting RT when they were on Phenytoin for quite some time prior to starting RT.

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Last edited on 08 Apr 2011 08:30 by Santam Chakraborty Show more