Vol 25, No 4 (2020)
Case reports
Published online: 2020-07-01

open access

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Adult Onset Still's Disease and Radiotherapy treatment for breast cancer: Case report about management of this rare association and literature review

Fabio Marazzi1, Valeria Masiello1, Gianluca Franceschini23, Silvia Bosello4, Francesca Moschella2, Daniela Smaniotto13, Stefano Luzi13, Antonino Mulé5, Maria Antonietta Gambacorta13, Elisa Gremese34, Riccardo Masetti23, Vincenzo Valentini13
DOI: 10.1016/j.rpor.2020.03.013
Rep Pract Oncol Radiother 2020;25(4):527-532.



This manuscript focuses on the first experience in literature of a patient with a complicated Adult Onset Still's Disease-related heart failure who thereafter underwent adjuvant radiotherapy for left breast cancer.


AOSD is a rare autoimmune inflammation-related disease, in which life-threatening pulmonary and cardiac complications can occur. In literature, AOSD is often associated with cancer, as paraneoplastic syndrome, but there are few data about primary AOSD and management of oncological therapies.

Materials and Methods

A patient who needed adjuvant breast cancer radiotherapy underwent tumour board evaluation to define feasibility of an RT in a patient with of a history of a heart life-threatening complication 2 years before AOSD. Results of the review were discussed by a multidisciplinary panel of experts that chose the type of surgery, radiotherapy and monitoring of patient.


Literature review confirmed association of AOSD with BC in some pts and uniqueness of this treatment management experience. Patient underwent RT according to schedule of 40.05/2.67Gy/fx on residual left breast and 10/2Gy/fx on tumour bed with the gating technique. The panel chose to keep immunosuppressive therapy with anakinra. No complications were observed at clinical, ECG and laboratory examinations. Maximum toxicity was G2 skin. At first follow up AOSD signs of flare were negative.


In conclusion, when oncological treatments, especially radiotherapy, are mandatory for AOSD pts, multidisciplinary management and tailored monitoring are necessary to avoid acute adverse effects and allow pts to complete therapies.

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Reports of Practical Oncology and Radiotherapy