Inflammatory reporting.

Sometimes we make major alterations to standard treatment recommendations based on very small but very scary case reports. The CONTRAD meta-analysis sought to collect and analyze toxicity outcomes for patients with inflammatory medical conditions that are historically contraindications to radiation. They included 18 studies with over 600 patients with collagen vascular disease (two-thirds) or inflammatory bowel disease (one-third) treated with radiation or chemoradiation. The estimated rates of grade 3+ acute and late toxicity for those with collagen vascular disease was 12% and 6%, respectively, and 15% and 10% for those with inflammatory bowel disease. Less than 5% had any grade 4 toxicity. These rates are not as scary as one might be led to believe, meaning the threshold for turning away from standard treatment recommendations in these populations deserve a raise.TBL: Patients with collagen vascular disease or inflammatory bowel disease have a 10-15% rate of grade 3 or higher toxicity from radiation. | Lin, Radiother Oncol 2019