How do you approach post operative radiation therapy to someone with head and neck cancer who has high risk of local recurrence who also has scleroderma?

While the risk of morphea (skin and subcutaneous damage ) after radiotherapy to breast ca is well documented, there are very few data about the risk in HNC. Searching Pubmed for: scleroderma, radiotherapy, and head neck, I get only 2 references, one of which is a case report of a severe late toxicity in one irradiated HNC pt. Specific literature search is difficult because the studies do not usually detail scleroderma in HNC pts vs other collagen vasc. diseases. In a paper from Mayo Clinic, of 22 pts with scleroderma irradiated, only 2 had HNC and both had sig. late toxicity https://www-sciencedirect-com.proxy.lib.umich.edu/science/article/pii/S0167814007006512. On the other hand, another study reported “no increase in either acute or late ...