Radiotherapy for Cervical Cancer in Patients with Systemic Lupus Erythematosus

OBJECTIVE: To determine the toxicity and efficacy of radiotherapy for cervical cancer in patients with systemic lupus erythematosus (SLE). METHODS: Medical records of patients with SLE who received radiation for cervical cancer from January 2011 to January 2019 were reviewed. For definitive radiotherapy, a dose of 50.4 Gy in 28 fractions was delivered by intensity-modulated radiation therapy (IMRT) combined with high-dose-rate brachytherapy of 28 to 30 Gy in 5 fractions. A dose of 45 to 50.4 Gy in 25–28 fractions was delivered for postoperative radiation. All patients were in remission with or without a low dosage of prednisone or immunosuppressive medication. Survival data were analyzed with the Kaplan–Meier method. The incidence of severe toxicities among patients was compared with the chi-square test or Fisher’s exact test. RESULTS: Twelve patients with SLE were included in this study. Definitive radiotherapy was delivered in 7 patients with FIGO (2009) stage II–III disease. Five patients with FIGO I disease received postoperative radiation. The median follow-up time was 22.1 months. The 3-year overall survival (OS) and 3-year progression-free survival (PFS) were 77.8% and 83.3%, respectively. One patient of definitive radiotherapy and one patient of postoperative radiation died due to distant metastasis of cervical cancer. Grade 3 or higher acute and chronic reactions occurred in 58.3% and 8.3% patients, respectively. Acute grade 3 or higher toxicity correlated with the presence of chemotherapy (p = 0.045). CONCLUSION: Modern radiotherapy for cervical cancer was well tolerated in SLE patients with remission and provided a favorable outcome.