Radiotherapy in the Management of Hidradenitis Suppurativa:

This project was conducted at Allegheny Health Network and Taussig Cancer Institute.

Could you please give a brief overview of your study and its findings?

Radiation therapy (RT) has been used to treat nonmalignant conditions for more than 100 years. However, over the past few years there has been a resurgence in the interest in using RT to treat nonmalignant conditions ranging from osteoarthritis to keloids (See ASTROnews 2024 Spring Issue, Volume 27 Number 2). One disease where RT can be considered is hidradenitis suppurativa (HS), a chronic autoinflammatory condition that can lead to abscesses, fistulas and significantly impact patient quality of life. Treatments range from steroids and antibiotics to systemic immunomodulators and surgical procedures.

At our institutions, we have seen an increase in patients diagnosed with HS as part of multidisciplinary collaboration. Our dermatologists have reached out to us to consider the role of RT, particularly for patients with recalcitrant disease or those unable to receive systemic therapy approaches. In creating institutional policies for indications, dose/fractionation and treatment techniques, we realized that while data were available, it was limited by small numbers, short follow-up and variable treatment techniques.

Why did you engage in this project?

We engaged in this project to provide clinicians a manuscript that not only reviewed the data surrounding the role of RT in the management of HS but also informed clinical practice by providing indications, dose ranges, target delineation and treatment technique approaches. We found a range of dose/fractionation regimens available, though prospective data was limited.

What did you find surprising about your research/results?

What was most surprising was the consistent benefit and limited toxicity that RT has demonstrated for HS patients, which is juxtaposed with its limited clinical utilization at this time.

How can this article be used to inform clinical practice?

It suggests that radiation therapy should increasingly be considered in the management of HS and that larger prospective studies are needed. Given the low RT doses needed, the excellent side effect profile, and ease with which treatments can be delivered (as compared to surgical procedures for example), with increasing data, RT may be increasingly considered earlier on in the management of HS.

This PRO article is available at https://www.practicalradonc.org/article/S1879-8500(25)00012-8/fulltext. Author disclosures are available in the article.