Presumed early-stage lung cancer treated with stereotactic body radiation therapy in a medically inoperable patient with multiple connective tissue disorders

Abstract

Patients with medically inoperable early stage nonsmall cell lung cancer are now routinely offered definitive treatment with stereotactic body radiation therapy (SBRT), which achieves excellent local control and provides a 3-year survival on the order of 60%, with less than 5% chance of severe toxicity. 1,2 However, the same medical comorbidities that make patients inoperable, such as diabetes and hypertension, are also thought to increase the risk of toxicity from radiation therapy.3 In general the comorbidities that may predispose patients to greater toxicity involve microvascular pathology. Connective tissue disorders (CTDs), including scleroderma, systemic lupus erythematous (SLE), dermatomyositis, polymyositis, rheumatoid arthritis, Sjogren’s syndrome, and mixed CTDs, have traditionally been considered a relative contraindication to radiation therapy since the effects on normal tissues could possibly be severe.4,5 SBRT generally involves a tightly focused, ablativeintent dose of radiation to a small target, with rapid dose