{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:52:16Z","timestamp":1777877536005,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head & Neck Surgery"],"published-print":{"date-parts":[[2025,9]]},"abstract":"\n Importance<\/jats:title>\n Limited evidence exists to guide the safe use of radiotherapy (RT) and concurrent disease-modifying antirheumatic drugs (DMARDs) in patients with collagen vascular disease (CVD).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To describe toxicity outcomes in patients with CVD receiving intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC) and to evaluate whether concurrent DMARD use is associated with increased toxicity.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Single academic tertiary care center in the United States, from 2005 to 2022.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Twenty-three adult patients with CVD [eg, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), dermatomyositis (DM)] and biopsy-proven HNC treated with curative-intent IMRT. Eligibility required available treatment records and \u226590\u2009days of follow-up post-RT.<\/jats:p>\n <\/jats:sec>\n \n Intervention or Exposures<\/jats:title>\n Definitive or postoperative IMRT for HNC. Exposure of interest was concurrent use of DMARDs during RT.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n Rates of acute (\u226490\u2009days) and late (>90\u2009days) grade \u22652 and \u22653 toxicities, as graded by CTCAE v5.0. Fisher exact tests were used to compare toxicity rates by DMARD use.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Median follow-up was 56\u2009months (IQR 9-98). Most common CVDs were RA (39%), SLE (17%), and DM (17%). Median RT dose was 66 Gy (range 48-70\u2009Gy); 39% received concurrent chemotherapy. Acute grade \u22653 toxicity occurred in 35% (n\u2009=\u20098) and late grade \u22653 in 13% (n\u2009=\u20093). No grade \u22654 toxicities were observed. DMARD use during RT was not associated with higher rates of acute or late grade \u22652 or \u22653 toxicity (\n P<\/jats:italic>\n \u2009>\u2009.1 for all comparisons).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n IMRT was associated with moderate rates of severe toxicity in patients with CVD, but DMARD use during RT did not increase risk.<\/jats:p>\n <\/jats:sec>\n \n Relevance<\/jats:title>\n Concurrent DMARDs may be safely continued during IMRT for HNC in patients with CVD. Prospective studies are needed to confirm these findings and refine risk stratification by CVD subtype and treatment regimen.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/19160216251379333","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T10:37:24Z","timestamp":1758796644000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Toxicities Associated with Continuing Disease-Modifying Antirheumatic Drugs for Collagen Vascular Diseases During Head and Neck Intensity-Modulated Radiotherapy: A Single-Institution Experience"],"prefix":"10.1177","volume":"54","author":[{"given":"Lisa","family":"Ni","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Phuong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0779-7476","authenticated-orcid":false,"given":"Sue S.","family":"Yom","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3152-1023","authenticated-orcid":false,"given":"Jason W.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(89)90074-6"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.7.2728"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(99)00103-0"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00417-9"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2019.03.006"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.08.006"},{"issue":"6","key":"e_1_3_2_8_2","first-page":"480","article-title":"Breast-conserving therapy in the setting of collagen vascular disease","volume":"7","author":"Chen AM","year":"2001","unstructured":"Chen AM, Obedian E, Haffty BG. Breast-conserving therapy in the setting of collagen vascular disease. Cancer J. 2001;7(6):480-491.","journal-title":"Cancer J"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00130404-200311000-00005"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23591"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(89)90344-1"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016489.2014.913312"},{"key":"e_1_3_2_13_2","unstructured":"National Institutes of Health. Common terminology criteria for adverse events (CTCAE) version 5.0. U.S. Department of Health and Human Services. Published November 27 2017. Accessed June 3 2025. https:\/\/dctd.cancer.gov\/research\/ctep-trials\/for-sites\/adverse-events\/ctcae-v5-5x7.pdf"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2006.06.013"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.11.5501"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70290-4"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2012.07.001"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2023.02.057"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(93)90167-T"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2019.12.004"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.01.008"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032646"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032641"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23865"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.4078\/jrd.2022.29.3.162"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.4078\/jrd.22.0034"}],"container-title":["Journal of Otolaryngology - Head & Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19160216251379333","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19160216251379333","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19160216251379333","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:54:06Z","timestamp":1777589646000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19160216251379333"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":25,"alternative-id":["10.1177\/19160216251379333"],"URL":"https:\/\/doi.org\/10.1177\/19160216251379333","relation":{},"ISSN":["1916-0216","1916-0216"],"issn-type":[{"value":"1916-0216","type":"print"},{"value":"1916-0216","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"article-number":"19160216251379333"}}