1
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Ben-David MA, Schwartz I, Eshed I, Levanon K. Gemcitabine-Induced Myonecrosis Following Hypofractionated Radiation. Cureus 2024; 16:e58591. [PMID: 38765409 PMCID: PMC11102761 DOI: 10.7759/cureus.58591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Palliative radiation is often used to abate pain and prevent bone fractures in patients with metastatic cancer. Hypofractionation, meaning delivery of larger doses of radiation in each treatment session (fraction), has become the standard of care in most cases. It not only reduces the burden on the medical system and facilitates the relief of symptoms but also enables the maintenance of the continuity of systemic therapy. Radiation recall phenomenon (RRP) is an acute inflammatory reaction in previously irradiated tissues that is provoked by chemotherapeutic drug administration. The incidence, severity, and prognosis of RRP following hypofractionated radiation therapy have not been studied. The symptoms of RRP depend on the radiation field, with the greatest concern associated with mucosal and dermal damage, though other symptoms have also been reported. Here, we describe a case of a 41-year-old woman with metastatic breast cancer (hormone receptor-positive, HER2/neu negative), who received palliative radiation to four other fields along the course of her disease, before her presentation with isolated myonecrosis of the thigh muscles. This RRP occurred four months following the last of two fractions of 8 Gy radiation to this region, given three months apart, and after six courses of cisplatin + gemcitabine. The symptoms improved with cessation of gemcitabine and prolonged administration of non-steroidal anti-inflammatory medications.
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Affiliation(s)
- Merav A Ben-David
- Department of Oncology, Assuta Medical Center, Tel Aviv, ISR
- Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, ISR
| | - Ignat Schwartz
- Department of Pathology, Sheba Medical Center, Ramat Gan, ISR
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, ISR
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, ISR
| | - Keren Levanon
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, ISR
- The Jusidman Cancer Center, Sheba Medical Center, Ramat Gan, ISR
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2
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Üçüncü Kefeli A, Aksu B. Docetaxel induces radiation recall myositis: A case report. Exp Ther Med 2022; 24:516. [DOI: 10.3892/etm.2022.11443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/12/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ayşegül Üçüncü Kefeli
- Department of Radiation Oncology, Kocaeli University Hospital, 41000 Kocaeli, Turkey
| | - Beyza Aksu
- Vocational School of Health Services, Kocaeli University Hospital, 41000 Kocaeli, Turkey
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3
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Suhag V, Purkayastha A, Sharma N, Taneja S, Lohia N. Sociodemographic, clinical profile, and treatment characteristics of oncology patients developing radiation recall phenomenon: Two tertiary care center's experience of an eternal unpredictable phenomenon of cancer treatment. Tzu Chi Med J 2022; 34:337-347. [PMID: 35912053 PMCID: PMC9333107 DOI: 10.4103/tcmj.tcmj_163_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/23/2021] [Accepted: 09/16/2021] [Indexed: 11/04/2022] Open
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4
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McKay MJ, Foster R. Radiation recall reactions: An oncologic enigma. Crit Rev Oncol Hematol 2021; 168:103527. [PMID: 34808375 DOI: 10.1016/j.critrevonc.2021.103527] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/23/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022] Open
Abstract
Radiation recall reactions (RRR) are uncommon but are a well-known phenomenon to oncologists. Tissue damage in a prior irradiation portal is 'recalled' after the administration of a drug, historically cytotoxics, or more recently, targeted or immunotherapeutic agents. Even COVID-19 vaccines are a reported cause. RRR are enigmatic in that their cause is unknown, but they generally have the histopathological and clinical features of acute or chronic inflammation. They can occur in a variety of tissues, the commonest being skin, which accounts for two-thirds of reported cases. They are generally relatively mild and self-limiting once the trigger drug is stopped, although severe cases with tissue necrosis have occurred. Rechallenge with drug does not necessarily cause reactivation of the reaction. Symptomatic treatment with steroids and antihistamines are usually effective, but their impact on the clinical course is unclear. Various hypotheses have been proposed as to the mechanism of RRR; a non-immune fixed drug reaction-like condition, dysregulated release of reactive oxygen species, abnormalities of tissue vasculature and impaired DNA repair. All could lead to a characteristic inflammatory microenvironment, resulting in dysfunction of tissue stem cells, keratinocyte necrosis and dermal abnormalities. Alternatively or in addition, low levels of inflammatory tissue cytokines induced by previous irradiation might be further upregulated by drug exposure. Most information in this review refers to data derived from cutaneous RRR, since they are the most common form reported.
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Affiliation(s)
- Michael J McKay
- Northern Cancer Service, North West Cancer Centre, Burnie, Tasmania, 7320, Australia; The University of Tasmania, Rural Clinical School, North West Regional Hospital, Burnie, Tasmania, 7320, Australia.
| | - Richard Foster
- Northern Cancer Service, North West Cancer Centre, Burnie, Tasmania, 7320, Australia
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5
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Barrios-Anderson A, Radhakrishnan R, Yu E, Shimanovsky A. Paraspinal radiation recall myositis after gemcitabine for pancreatic adenocarcinoma. BMJ Case Rep 2021; 14:e240896. [PMID: 33947675 PMCID: PMC8098950 DOI: 10.1136/bcr-2020-240896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 01/02/2023] Open
Abstract
Radiation recall (RR) is a chemotherapy-induced reaction that leads to inflammation and necrosis in previously irradiated tissue. Gemcitabine is a cytidine analogue that is often used in conjunction with nab-paclitaxel in the treatment of pancreatic cancer. Herein, we present a case of a 56-year-old woman with stage III pancreatic adenocarcinoma diagnosed with gemcitabine-induced RR when she presented with lower back pain and new rim-enhancing collections within the right and left paraspinal musculature 5 months after radiation therapy to the pancreas. A PubMed search was performed for 'Radiation Recall Myositis' and a complete literature review performed. This case and review of the literature of published cases of RR myositis highlight the clinical course and presentation of RR myositis. This review highlights the importance of considering RR in the differential diagnosis when patients who are undergoing chemotherapy and radiation present with inflammatory changes in previously irradiated areas.
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Affiliation(s)
| | | | - Esther Yu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alexei Shimanovsky
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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6
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Masson I, Supiot S, Doutriaux-Dumoulin I, Thillays F. Report of a unique case of gemcitabine-induced radiation recall myelitis following spinal cord irradiation. BJR Case Rep 2020; 6:20190118. [PMID: 32922834 PMCID: PMC7465732 DOI: 10.1259/bjrcr.20190118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/18/2020] [Accepted: 04/15/2020] [Indexed: 11/22/2022] Open
Abstract
Radiation recall is a rare phenomenon, defined as an acute inflammatory reaction in a previously irradiated area, after administration of anti-tumor agents, including chemotherapy. It is most commonly reported to trigger skin reactions but internal organ involvement is possible, particularly with gemcitabine. We report here a unique case of a gemcitabine-induced radiation recall myelitis following spinal irradiation. A 53-year-old patient received analgesic irradiation of the seventh thoracic vertebra (T7) in the context of metastatic non-small cell lung cancer, at conventional radiotherapy dose and fractionation. She was subsequently treated with gemcitabine and developed myelitis whose chronology is compatible with a radiation recall reaction. Spinal MRI confirmed a T6-T7 spinal cord enhancement, with an associated spinal cord oedema. Corticosteroids and supportive care did not improve myelitis symptoms. The patient died within a year of the radiation recall, due to a metastatic progression of lung cancer. This is, to our knowledge, the first reported case of gemcitabine-induced radiation recall myelitis and only the third case involving the spinal cord. Radiation recall is a rare and poorly understood phenomenon and all cases should be reported.
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Affiliation(s)
- Ingrid Masson
- Department of Radiation Oncology, Institut de cancérologie de l’Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | | | - Isabelle Doutriaux-Dumoulin
- Department of Radiology, Institut de cancérologie de l’Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - François Thillays
- Department of Radiation Oncology, Institut de cancérologie de l’Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
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7
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Patel NV, Samuels M, Elsayyad N. Ceftriaxone‐induced
radiation recall dermatitis. Head Neck 2020; 42:E8-E11. [DOI: 10.1002/hed.26154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/20/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nirav V. Patel
- Department of Radiation OncologyUniversity of Miami Sylvester Comprehensive Cancer Center Miami Florida USA
| | - Michael Samuels
- Department of Radiation OncologyUniversity of Miami Sylvester Comprehensive Cancer Center Miami Florida USA
| | - Nagy Elsayyad
- Department of Radiation OncologyUniversity of Miami Sylvester Comprehensive Cancer Center Miami Florida USA
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8
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Lemay J, Bouchard M, Rousseau É. Radiation Recall Myositis Detected With 18F-FDG PET/CT After a Treatment of Cervical Cancer. Clin Nucl Med 2020; 45:e336-e338. [DOI: 10.1097/rlu.0000000000003024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Hack E, Thachil T, Karanth N. Pectoralis major radiation recall. J Med Radiat Sci 2019; 66:62-65. [PMID: 30198200 PMCID: PMC6399193 DOI: 10.1002/jmrs.303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/03/2018] [Indexed: 12/12/2022] Open
Abstract
Radiation recall is an uncommon phenomenon describing an acute localised inflammatory toxicity affecting tissue previously exposed to radiotherapy. It is precipitated by administration of certain medications, including chemotherapy. We describe a case involving a 50-year-old Aboriginal male smoker from a remote community in Northern Australia who underwent treatment for stage IV non-small cell lung cancer with localised radiotherapy to the primary right upper lung lobe tumour. This was followed by a course of gemcitabine, which was ceased prematurely after four cycles when he presented with radiation recall to his right pectoralis major. Our case description is complemented with a brief review of current literature regarding our case and gemcitabine-related radiation recall. This was in the context of concurrent musculoskeletal strain, an as-yet unreported association with radiation recall. His condition settled with steroid administration and discontinuation of gemcitabine.
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Affiliation(s)
- Emma Hack
- Department of MedicineRoyal Darwin HospitalTiwiNorthern TerritoryAustralia
| | - Thanuja Thachil
- Department of MedicineRoyal Darwin HospitalTiwiNorthern TerritoryAustralia
| | - Narayan Karanth
- Department of MedicineRoyal Darwin HospitalTiwiNorthern TerritoryAustralia
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10
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Ravishankar A, Park SS, Olivier KR, Corbin KS. Gemcitabine-Induced Radiation Recall Myositis: Case Report and Review of the Literature. Case Rep Oncol 2018; 11:168-178. [PMID: 29681817 PMCID: PMC5903158 DOI: 10.1159/000487478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 12/18/2022] Open
Abstract
Gemcitabine-induced radiation recall (GIRR) is a phenomenon wherein the administration of gemcitabine induces an inflammatory reaction within an area of prior radiation. We present the case of a 39-year-old female patient with metastatic breast cancer who experienced GIRR myositis 3 months following postoperative radiotherapy, with additional potential paraspinal myositis following ablative radiotherapy to the thoracic spine. A review of previously published cases of GIRR myositis was performed. The case and literature review describe the clinical course and presentation of GIRR, and highlight the importance of including radiation recall as part of a differential diagnosis when a patient undergoing chemotherapy experiences an inflammatory reaction at a prior site of radiation.
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Affiliation(s)
| | - Sean S Park
- Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth R Olivier
- Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kimberly S Corbin
- Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Mujtaba B, Narayanan S, Eugene Koay J, Elshikh M, E Madewell J, R Varadhachary G. Radiation Recall Masquerading as an Infectious Process. ACTA ACUST UNITED AC 2017. [DOI: 10.15406/ijrrt.2017.02.00047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Prabhakar N, Goyal U, Gonzalez VJ. Irinotecan-induced radiation-recall myositis in a patient with metastatic breast cancer: A case report. Pract Radiat Oncol 2017; 7:302-305. [PMID: 28336481 DOI: 10.1016/j.prro.2017.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/06/2017] [Accepted: 01/16/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Uma Goyal
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona.
| | - Victor J Gonzalez
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona
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13
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Faiz SA, Balachandran DD, Bashoura L, Shannon VR. Pulmonary Radiation Recall Induced by Gemcitabine. Am J Respir Crit Care Med 2016; 194:909-910. [DOI: 10.1164/rccm.201606-1235im] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Tomiguchi M, Yamamoto Y, Hayashi M, Yamamoto-Ibusuki M, Murakami K, Iwase H. Docetaxel and cyclophosphamide chemotherapy induced radiation recall phenomenon in a postoperative breast cancer patient: a case report. Int Cancer Conf J 2016; 5:202-205. [PMID: 31149455 DOI: 10.1007/s13691-016-0258-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022] Open
Abstract
The radiation recall phenomenon (RRP) is an acute inflammatory reaction at a site previously treated with radiation, and is triggered by anti-cancer therapies such as chemotherapy or antibiotics. A 48-year-old Japanese woman with primary breast cancer underwent partial mastectomy and sentinel lymph node biopsy followed by postoperative radiotherapy. Subsequent to breast-conserving surgery, adjuvant chemotherapy, including docetaxel in combination with cyclophosphamide (TC), was administrated after 16 days of radiotherapy involving the right breast. The patient experienced the RRP with erythema and burning pain at the site of the irradiation fields at 6 days after the administration of TC. The skin symptoms resolved after treatment with topical corticosteroid therapy over a few days. After the second course of TC, the patient had only mild symptoms relative to the first course. She successfully completed four cycles of TC without dose reduction and treatment delay. We report this case involving the RRP induced by TC together with a review of the literature.
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Affiliation(s)
- Mai Tomiguchi
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Yutaka Yamamoto
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Mitsuhiro Hayashi
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Mutsuko Yamamoto-Ibusuki
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan.,2Department of Molecular-Targeting Therapy for Breast Cancer, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Keiichi Murakami
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Hirotaka Iwase
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
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15
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Mattes MD, Cardinal JS, Jacobson GM. Delayed radiation-induced inflammation accompanying a marked carbohydrate antigen 19-9 elevation in a patient with resected pancreatic cancer. Radiat Oncol J 2016; 34:156-9. [PMID: 27306770 PMCID: PMC4938345 DOI: 10.3857/roj.2016.01732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/25/2016] [Accepted: 06/03/2016] [Indexed: 12/13/2022] Open
Abstract
Although carbohydrate antigen (CA) 19-9 is a useful tumor marker for pancreatic cancer, it can also become elevated from a variety of benign and malignant conditions. Herein we describe an unusual presentation of elevated CA 19-9 in an asymptomatic patient who had previously undergone adjuvant chemotherapy and radiation therapy for resected early stage pancreatic cancer. The rise in CA 19-9 might be due to delayed radiation-induced inflammation related to previous intra-abdominal radiation therapy with or without radiation recall induced by gemcitabine. After treatment with corticosteroids the CA 19-9 level decreased to normal, and the patient has not developed any evidence of recurrent cancer to date.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Jon S Cardinal
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Geraldine M Jacobson
- Department of Radiation Oncology, West Virginia University School of Medicine, Morgantown, WV, USA
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16
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Gemcitabine-induced radiation recall myositis in a patient with relapsed nasopharyngeal carcinoma. Pract Radiat Oncol 2016; 7:e19-e22. [PMID: 27637134 DOI: 10.1016/j.prro.2016.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/28/2022]
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17
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Delavan JA, Chino JP, Vinson EN. Gemcitabine-induced radiation recall myositis. Skeletal Radiol 2015; 44:451-5. [PMID: 25193536 DOI: 10.1007/s00256-014-1996-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 07/31/2014] [Accepted: 08/20/2014] [Indexed: 02/02/2023]
Abstract
Radiation recall is an uncommon phenomenon in which administration of a chemotherapeutic agent induces an acute inflammatory reaction in previously irradiated tissues, often weeks to years after completion of radiotherapy. This entity is well known to medical and radiation oncologists, however only three cases have been reported in radiology journals. We present a case of gemcitabine-induced radiation recall that manifested as myositis with associated dermatitis in the posterior thigh of a patient with remote history of localized radiotherapy for biopsy-proven breast cancer metastasis. We also present a brief literature review to update the topic of radiation recall in imaging, and emphasize the importance of knowledge of this phenomenon when considering the differential diagnosis of myositis/dermatitis in a patient who has received cancer treatment.
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Affiliation(s)
- Joshua Adam Delavan
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA,
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18
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Rodríguez-Ruiz ME, Arévalo E, Gil-Bazo I, Olarte García A, Valtueña G, Moreno-Jiménez M, Arbea-Moreno L, Aristu J. Pneumomediastinum as a complication of SABR for lung metastases. Radiat Oncol 2015; 10:25. [PMID: 25612575 PMCID: PMC4313462 DOI: 10.1186/s13014-015-0330-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic ablative body radiation (SABR) is a novel and sophisticated radiation modality that involves the irradiation of extracranial tumors through precise and very high doses in patients with oligometastatic lung disease and primary lung tumors. CASE PRESENTATION A 52-year-old female with subclinical idiopathic interstitial lung disease (ILD) and oligometastatic lung disease from squamous urethral cancer who was treated with SABR for a metastatic lesion located in the right lower pulmonary lobe. The patient received a hypo-fractionated course of SABR. A 3D-conformal multifield technique was used with six coplanar and one non-coplanar statics beams. A 48 Gy total dose in three fractions over six days was prescribed to the 95% of the PTV. The presence of idiopathic ILD and other identifiable underlying lung conditions were not taken into account as a constraint to prescribe a different than standard total dose or fractionation schedule. Six months after the SABR treatment, a CT-scan showed the presence of a pneumomediastinum with air outside the bronchial tree and within the subcutaneous tissue without co-existing pneumothorax. To our knowledge, this is the first case of pneumomediastinum appearing 6 months after SABR treatment for a lung metastasis located in the perihiliar/central tumors region as defined by the RTOG protocols as the proximal bronchial tree. CONCLUSION Radiation oncologist should be aware of the potential risk of severe lung toxicity caused by SABR in patients with ILD, especially when chemotherapy-induced pulmonary toxicity is administered in a short time interval.
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19
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Grover S, Jones JA, Teitelbaum U, Apisarnthanarax S. Radiation recall myositis: two sites, one patient. Pract Radiat Oncol 2014; 5:39-42. [PMID: 25413426 DOI: 10.1016/j.prro.2014.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/18/2014] [Accepted: 03/20/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Joshua A Jones
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ursina Teitelbaum
- Department of Medicine, Division of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Cutaneous reactions to chemotherapeutic drugs and targeted therapies for cancer: part I. Conventional chemotherapeutic drugs. J Am Acad Dermatol 2014; 71:203.e1-203.e12; quiz 215-6. [PMID: 25037800 DOI: 10.1016/j.jaad.2014.04.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/07/2014] [Accepted: 04/09/2014] [Indexed: 02/07/2023]
Abstract
Conventional chemotherapy continues to be an important part of cancer management, but may cause various cutaneous reactions because it disturbs specific cell cycle phases. The alkylating agents cyclophosphamide, ifosfamide, and thiotepa can produce hyperpigmentation, while hypersensitivity reactions can be seen with platinum alkylating agents. Antimetabolites vary in reactions from exanthematous to bullous skin lesions. 5-fluorouracil and its derivatives and liposomal doxorubicin and daunorubicin are characteristically known to cause hand-foot syndrome, while bleomycin can cause fibrosis and flagellate dermatitis. Several hypersensitivity reactions may also occur from mitotic inhibitors and topoisomerase inhibitors. These different characteristic presentations are important to dermatologists in identifying the correct diagnosis and management for the cancer patient.
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21
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Kindts I, Stellamans K, Bonny M, Planckaert N, Goethals L. Case report of cold-weather-induced radiation recall dermatitis after chemoradiotherapy with cisplatin. Strahlenther Onkol 2014; 190:762-6. [PMID: 24699987 DOI: 10.1007/s00066-014-0632-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The radiation recall reaction (RRR) is an inflammatory reaction that occurs in previously irradiated areas. The phenomenon is probably due to an idiosyncratic hypersensitivity reaction, in which a second agent can recall the inflammatory reaction. CASE REPORT This case report documents a cold-weather-induced radiation recall dermatitis (RRD). We observed a severe RRD in a patient after chemoradiotherapy treatment with cisplatin for a nasopharyngeal carcinoma, precipitated by cold temperatures, which developed 9 days after completion of therapy. In the medical literature, RRD following extreme cold temperatures seems to be a peculiar event. CONCLUSION Until further information on the interaction is available, future studies on combined chemotherapy with cisplatin should be carefully monitored and any side effects clearly documented. This case suggests that environmental conditions may play a contributing role in the development of RRD. This case also implies that neither fraction size nor total radiation dose is a determining factor in the development of the dermatologic reaction.
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Affiliation(s)
- Isabelle Kindts
- Department of Radiation Oncology, AZ Groeninge Hospital, Loofstraat 43, 8500, Kortrijk, Belgium,
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22
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Gemcitabine-induced myopathy. Semin Arthritis Rheum 2013; 43:784-91. [PMID: 24387817 DOI: 10.1016/j.semarthrit.2013.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 11/19/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND There have been few studies on muscle injury caused by cytotoxic agents used in cancer. In particular, only four cases of muscle manifestations have been reported in patients who received gemcitabine as single chemotherapy without adjuvant radiotherapy. In only one of these observations gemcitabine was considered to be the causative agent. METHODS We report the case of a patient without comorbidity treated with gemcitabine monotherapy for 2 months for pancreatic adenocarcinoma, who developed a proximal motor deficiency of the lower limbs and myolysis (creatinine kinase 1858 IU/L) associated with an erythema of both thighs. RESULTS Muscle MRI revealed the presence of edema on both the quadriceps muscles. A muscle biopsy showed post-necrotic regeneration and significant vascular proliferation. Only three small inflammatory infiltrates were observed, while expression of the major histocompatibility complex class I in muscle fibers was normal. There was no recurrence of cancer, anti-TIF-1γ antibodies tested negative, and discontinuation of gemcitabine, without further treatment, resulted in complete disappearance of symptoms. CONCLUSIONS The present observation suggests that gemcitabine monotherapy without adjuvant radiotherapy can cause myopathy through vascular lesions, a mechanism which also underlies the more common side effects of this treatment. These findings have obvious therapeutic implications.
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Acevedo F, Arriagada P, Ibañez C, Ortega C, Muñoz P, Borghero Y, Bustos M, Sanchez C. Radiation recall dermatitis: report of two cases. Int Cancer Conf J 2013. [DOI: 10.1007/s13691-013-0099-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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A child with gemcitabine-induced severe radiation recall myositis resulting in a compartment syndrome. J Pediatr Hematol Oncol 2013; 35:156-61. [PMID: 23274380 DOI: 10.1097/mph.0b013e31827e4c28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chemotherapeutic induction of radiation recall (RR) is a rare event in which a chemotherapeutic agent given days to years after radiation therapy causes an inflammation reaction of the tissues within the irradiated area-"recalling" increased radiation effects to that area. In this unique case, a 14-year-old girl with a synovial sarcoma of the forearm was treated with neoadjuvant chemotherapy and radiation therapy. Gemcitabine was administered in an adjuvant setting inducing a RR reaction. The severity of the inflammation resulted in a forearm myositis secondarily causing a compartment syndrome that was treated with several prolonged courses of corticosteroids. The symptoms of RR and compartment syndrome have resolved 1 year postonset, although magnetic resonance imaging continues to show myositis and soft-tissue edema. This case highlights the need to maintain a heightened awareness to recognizing the signs and symptoms of RR and the potential severity of RR in pediatric cancer patients in conjunction with chemotherapeutic agents used more frequently in adults.
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Hattangadi J, Esty B, Winey B, Duigenan S, Huang M, Yock T. Radiation recall myositis in pediatric Ewing sarcoma. Pediatr Blood Cancer 2012; 59:570-2. [PMID: 22021129 DOI: 10.1002/pbc.23374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 09/06/2011] [Indexed: 11/06/2022]
Abstract
Radiation recall is a rare and poorly understood phenomenon, characterized by an acute inflammatory reaction within the previously irradiated area, triggered by a precipitating systemic agent. This reaction typically affects the skin, and radiation recall myositis in the absence of cutaneous involvement has rarely been described in the literature. In this report, we present two cases of radiation recall in pediatric Ewing sarcoma patients receiving successive proton radiotherapy and chemotherapy, with magnetic resonance imaging (MRI) of muscle edema within the prior radiation fields.
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Affiliation(s)
- Jona Hattangadi
- Harvard Radiation Oncology Program, Boston, Massachusetts 02215, USA.
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Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ, Aleman BM, Edgar AB, Mabuchi K, Muirhead CR, Shore RE, Wallace WH. ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs--threshold doses for tissue reactions in a radiation protection context. Ann ICRP 2012; 41:1-322. [PMID: 22925378 DOI: 10.1016/j.icrp.2012.02.001] [Citation(s) in RCA: 771] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This report provides a review of early and late effects of radiation in normal tissues and organs with respect to radiation protection. It was instigated following a recommendation in Publication 103 (ICRP, 2007), and it provides updated estimates of 'practical' threshold doses for tissue injury defined at the level of 1% incidence. Estimates are given for morbidity and mortality endpoints in all organ systems following acute, fractionated, or chronic exposure. The organ systems comprise the haematopoietic, immune, reproductive, circulatory, respiratory, musculoskeletal, endocrine, and nervous systems; the digestive and urinary tracts; the skin; and the eye. Particular attention is paid to circulatory disease and cataracts because of recent evidence of higher incidences of injury than expected after lower doses; hence, threshold doses appear to be lower than previously considered. This is largely because of the increasing incidences with increasing times after exposure. In the context of protection, it is the threshold doses for very long follow-up times that are the most relevant for workers and the public; for example, the atomic bomb survivors with 40-50years of follow-up. Radiotherapy data generally apply for shorter follow-up times because of competing causes of death in cancer patients, and hence the risks of radiation-induced circulatory disease at those earlier times are lower. A variety of biological response modifiers have been used to help reduce late reactions in many tissues. These include antioxidants, radical scavengers, inhibitors of apoptosis, anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, growth factors, and cytokines. In many cases, these give dose modification factors of 1.1-1.2, and in a few cases 1.5-2, indicating the potential for increasing threshold doses in known exposure cases. In contrast, there are agents that enhance radiation responses, notably other cytotoxic agents such as antimetabolites, alkylating agents, anti-angiogenic drugs, and antibiotics, as well as genetic and comorbidity factors. Most tissues show a sparing effect of dose fractionation, so that total doses for a given endpoint are higher if the dose is fractionated rather than when given as a single dose. However, for reactions manifesting very late after low total doses, particularly for cataracts and circulatory disease, it appears that the rate of dose delivery does not modify the low incidence. This implies that the injury in these cases and at these low dose levels is caused by single-hit irreparable-type events. For these two tissues, a threshold dose of 0.5Gy is proposed herein for practical purposes, irrespective of the rate of dose delivery, and future studies may elucidate this judgement further.
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Ryu YS, Jeon CH. A Case of Radiation Recall Myositis Induced by 5-FU and Cisplatin. JOURNAL OF RHEUMATIC DISEASES 2012. [DOI: 10.4078/jrd.2012.19.1.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yang Seon Ryu
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
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Gemcitabine-Induced Acute Myositis in a Patient with Duodenal Cancer. Clin Oncol (R Coll Radiol) 2011; 23:492-3. [DOI: 10.1016/j.clon.2011.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 02/09/2011] [Indexed: 11/20/2022]
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Pentsova E, Liu A, Rosenblum M, O’Reilly E, Chen X, Hormigo A. Gemcitabine induced myositis in patients with pancreatic cancer: case reports and topic review. J Neurooncol 2011; 106:15-21. [DOI: 10.1007/s11060-011-0672-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 07/18/2011] [Indexed: 11/30/2022]
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Gemcitabine-associated "pseudocellulitis" and "pseudosepsis": a case report and review of the literature. Am J Ther 2011; 20:118-20. [PMID: 21768869 DOI: 10.1097/mjt.0b013e3182204ffe] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chemotherapeutic agents have been associated with sepsis and a variety of opportunistic and nonopportunistic infections. This was attributed to their immunosuppressive effects. Like all other chemotherapeutic agents, the use of gemcitabine has been associated with different infectious processes, yet many conditions that mimic infections have also been linked to its use. Pseudosepsis is a condition that should be added to these previously described conditions, such as gemcitabine-induced pseudocellulitis. We describe a patient who suffered from 2 different gemcitabine-induced adverse events including pseudocellulitis that was not related to prior lymphedema or radiation recall phenomenon and pseudosepsis wherein antibiotics have no role in the treatment, and the discontinuation of the offending agent resulted in the resolution of the patient's symptoms.
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Wo JY, Ryan DP, Kulke MH, Hong TS. Radiation recall associated with insulin growth factor 1R antibody. Pract Radiat Oncol 2011; 1:208-11. [PMID: 24673952 DOI: 10.1016/j.prro.2010.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/14/2010] [Accepted: 12/18/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - David P Ryan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew H Kulke
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Ding X, Ji W, Li J, Zhang X, Wang L. Radiation recall pneumonitis induced by chemotherapy after thoracic radiotherapy for lung cancer. Radiat Oncol 2011; 6:24. [PMID: 21375774 PMCID: PMC3063220 DOI: 10.1186/1748-717x-6-24] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/06/2011] [Indexed: 11/24/2022] Open
Abstract
Background Radiation recall pneumonitis (RRP) describes a rare reaction in previously irradiated area of pulmonary tissue after application of triggering agents. RRP remains loosely characterized and poorly understood since it has so far only been depicted in 8 cases in the literature. The objective of the study is to disclose the general characteristics of RRP induced by chemotherapy after thoracic irradiation for lung cancer, and to draw attention to the potential toxicity even after a long time interval from the previous irradiation. Methods Medical records were reviewed. RRP induced by chemotherapy was diagnosed by the history of chemotherapy after radiotherapy, clinical presentation and radiographic abnormalities including ground-glass opacity, attenuation, or consolidation changes within the radiation field, plus that radiographic examination of the thorax before showed no radiation pneumonitis. RRP was graded according to Common Terminology Criteria for Adverse Events version 3.0. The characteristics of the 12 RRP cases were analyzed. Results Twelve patients were diagnosed of RRP, of who 8 received taxanes. The median time interval between end of radiotherapy and RRP, between end of radiotherapy and beginning of chemotherapy, and between beginning of chemotherapy and RRP was 95 days, 42 days and 47 days, respectively. Marked symptomatic and radiographic improvement was observed in the 12 patients after withdrawal of chemotherapy and application of systemic corticosteroids. Seven patients were rechallenged with chemotherapy, of whom four with the same kind of agents, and showed no recurrence with steroid cover. Conclusions Doctors should pay attention to RRP even after a long time from the previous radiotherapy or after several cycles of consolidation chemotherapy. Taxanes are likely to be associated with radiation recall more frequently. Withdrawal of causative agent and application of steroids are the treatment of choice. Patients may be rechallenged safely with steroid cover and careful observation, which needs to be validated.
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Affiliation(s)
- Xiao Ding
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
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LOCK MICHAEL, SINCLAIR KEVIN, WELCH STEPHEN, YOUNUS JAWAID, SALIM MOHAMMAD. Radiation recall dermatitis due to gemcitabine does not suggest the need to discontinue chemotherapy. Oncol Lett 2011; 2:85-90. [PMID: 22870134 PMCID: PMC3412512 DOI: 10.3892/ol.2010.195] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 08/26/2010] [Indexed: 11/06/2022] Open
Abstract
Radiation recall is common following treatment with certain chemotherapy drugs and presents frequently as a skin reaction. With gemcitabine, such a recall phenomenon may affect internal tissues and presents itself as myositis. Although such reactions have previously been reported in the literature, whether or not to continue chemotherapy during such reactions remains controversial. We reported a case of radiation recall in a patient treated with gemcitabine and radiation therapy that presented as myositis. We were able to continue palliative chemotherapy and manage the side effects with supportive care treatment. This case report provides partial support for the continuation of chemotherapy when required even when a recall reaction is encountered.
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Affiliation(s)
- MICHAEL LOCK
- Division of Radiation Oncology, London Regional Cancer Program, London, Ontario N6A 4L6, Canada
| | - KEVIN SINCLAIR
- Division of Radiation Oncology, London Regional Cancer Program, London, Ontario N6A 4L6, Canada
| | - STEPHEN WELCH
- Division of Medical Oncology, London Regional Cancer Program, London, Ontario N6A 4L6, Canada
| | - JAWAID YOUNUS
- Division of Medical Oncology, London Regional Cancer Program, London, Ontario N6A 4L6, Canada
| | - MOHAMMAD SALIM
- Division of Radiation Oncology, London Regional Cancer Program, London, Ontario N6A 4L6, Canada
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Abstract
There is still much that needs to be understood about radiation recall, and it is not currently possible to predict which patients will be affected and to which drugs they will react. Furthermore, there are no clearly defined characteristics of drugs that cause radiation recall, and thus, it is a possibility that must be kept in mind with use of any drug after radiotherapy, including those from new drug classes. Although it is not yet possible to design treatment regimens to eliminate the risk of radiation recall, it seems likely that risks can be minimized by prolonging the interval between completion of radiotherapy and initiation of full-dose chemotherapy. Radiation recall is an acute inflammatory reaction confined to previously irradiated areas that can be triggered when chemotherapy agents are administered after radiotherapy. It remains a poorly understood phenomenon, but increased awareness may aid early diagnosis and appropriate management. A diverse range of drugs used in the treatment of cancer has been associated with radiation recall. As most data come from case reports, it is not possible to determine the true incidence, but to date the antineoplastic drugs for which radiation recall reactions have been most commonly reported include the anthracycline doxorubicin, the taxanes docetaxel and paclitaxel, and the antimetabolites gemcitabine and capecitabine. Radiation recall is drug-specific for any individual patient; it is not possible to predict which patients will react to which drugs, and rechallenge does not uniformly induce a reaction. There are no identifiable characteristics of drugs that cause radiation recall, and thus, it is a possibility that must be kept in mind with use of any drug after radiotherapy, including those from new drug classes. Although it is not yet possible to design treatment regimens to eliminate the risk of radiation recall, it seems likely that risks can be minimized by prolonging the interval between completion of radiotherapy and initiation of chemotherapy.
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Abstract
Radiation recall is a well-known phenomenon that involves the "recall" of an acute inflammatory reaction in a previously irradiated region after administration of certain drugs. The most common type of radiation recall is radiation recall dermatitis, which involves the reoccurrence of an acute inflammatory skin reaction in previously irradiated skin. Most radiation recall reactions are attributable to chemotherapeutic agents. One previously reported case of radiation recall dermatitis occurred after administration of an antibiotic. The present case report is the second of radiation recall dermatitis involving an antibiotic: azithromycin.
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Affiliation(s)
- O Vujovic
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario.
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Heirwegh G, Bruyeer E, Renard M, Uyttebroeck A, Demaerel P. Radiation-recall myositis presenting as low-back pain (2010: 4b). Eur Radiol 2010; 20:1799-801. [PMID: 20532514 DOI: 10.1007/s00330-009-1562-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/13/2009] [Accepted: 07/27/2009] [Indexed: 11/24/2022]
Abstract
We report on a patient with a history of Ewing sarcoma who underwent surgery and subsequent adjuvant chemotherapy and radiotherapy. He developed low-back pain 6 months after the end of the radiotherapy and during consolidation chemotherapy. Magnetic resonance imaging showed evidence of myositis corresponding to the 'radiation-recall phenomenon', an inflammatory reaction of irradiated tissue.
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Affiliation(s)
- Geert Heirwegh
- Department of Radiology, AZ Damiaanziekenhuis, Oostende, Belgium
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Shueng PW, Lin SC, Chang HT, Chong NS, Chen YJ, Wang LY, Hsieh YP, Hsieh CH. Toxicity risk of non-target organs at risk receiving low-dose radiation: case report. Radiat Oncol 2009; 4:71. [PMID: 20043839 PMCID: PMC2806297 DOI: 10.1186/1748-717x-4-71] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 12/31/2009] [Indexed: 01/21/2023] Open
Abstract
The spine is the most common site for bone metastases. Radiation therapy is a common treatment for palliation of pain and for prevention or treatment of spinal cord compression. Helical tomotherapy (HT), a new image-guided intensity modulated radiotherapy (IMRT), delivers highly conformal dose distributions and provides an impressive ability to spare adjacent organs at risk, thus increasing the local control of spinal column metastases and decreasing the potential risk of critical organs under treatment. However, there are a lot of non-target organs at risk (OARs) occupied by low dose with underestimate in this modern rotational IMRT treatment. Herein, we report a case of a pathologic compression fracture of the T9 vertebra in a 55-year-old patient with cholangiocarcinoma. The patient underwent HT at a dose of 30 Gy/10 fractions delivered to T8-T10 for symptom relief. Two weeks after the radiotherapy had been completed, the first course of chemotherapy comprising gemcitabine, fluorouracil, and leucovorin was administered. After two weeks of chemotherapy, however, the patient developed progressive dyspnea. A computed tomography scan of the chest revealed an interstitial pattern with traction bronchiectasis, diffuse ground-glass opacities, and cystic change with fibrosis. Acute radiation pneumonitis was diagnosed. Oncologists should be alert to the potential risk of radiation toxicities caused by low dose off-targets and abscopal effects even with highly conformal radiotherapy.
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Affiliation(s)
- Pei-Wei Shueng
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan.
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Cole PD, Schwartz CL, Drachtman RA, de Alarcon PA, Chen L, Trippett TM. Phase II study of weekly gemcitabine and vinorelbine for children with recurrent or refractory Hodgkin's disease: a children's oncology group report. J Clin Oncol 2009; 27:1456-61. [PMID: 19224841 PMCID: PMC2668553 DOI: 10.1200/jco.2008.20.3778] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 12/12/2008] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Children's Oncology Group conducted this phase II study to assess the efficacy and toxicity of gemcitabine and vinorelbine (GV) in pediatric patients with heavily pretreated relapsed/refractory Hodgkin's disease. Both agents have significant single-agent response rates in this setting. METHODS GV was given on days 1 and 8 of each 21-day treatment cycle: vinorelbine 25 mg/m(2)/dose administered via intravenous (IV) push before gemcitabine 1,000 mg/m(2)/dose IV over 100 minutes. Any patients who demonstrated a measurable response (complete response [CR], very good partial response [VGPR], or partial response [PR]) were considered to have experienced a response to GV. Response was evaluated after every two cycles. A two-stage minimax rule was used to test the null hypothesis that the response rate is RESULTS Thirty eligible patients with a median age of 17.7 years (range, 10.7 to 29.4 years) were enrolled. All patients had received at least two prior chemotherapy regimens, and 17 patients had undergone prior autologous stem-cell transplantation. Hematologic toxicity was predominant in all treatment cycles. Nonhematologic grade 3 to 4 toxicity, including elevated hepatic enzymes and hyperbilirubinemia, was less common. Pericardial and pleural effusions developed in one patient after cycles 4 and 5 of GV, consistent with gemcitabine-induced radiation recall. There were no toxic deaths. Measurable responses were seen in 19 (76%) of 25 assessable patients (95% exact binomial CI, 55% to 91%), including six CRs, 11 VGPRs, and two PRs. CONCLUSION GV is an effective and well-tolerated reinduction regimen for children with relapsed or refractory Hodgkin's disease.
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WAN ZAINON WMN, BORG M, HIGGS B, YEOH E, KOTASEK D, PARNIS F, HILLENBAND E, HAMZAH S. Gemcitabine-induced radiation recall in the treatment of pancreatic cancer. Asia Pac J Clin Oncol 2009. [DOI: 10.1111/j.1743-7563.2009.01187.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Soltys SG, Kalani MYS, Cheshier SH, Szabo KA, Lo A, Chang SD. Stereotactic radiosurgery for a cardiac sarcoma: a case report. Technol Cancer Res Treat 2008; 7:363-8. [PMID: 18783285 DOI: 10.1177/153303460800700502] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary artery intimal sarcoma is an uncommon tumor with a poor prognosis. We report a case of a 75-year-old man with a pulmonary artery sarcoma, recurrent following surgical resection. To palliate symptoms of this recurrence, he underwent CyberKnife stereotactic radiosurgery with a clinical and radiographic response of his treated disease. No acute or sub-acute toxicity was seen until the patient's death due to metastatic disease 10 weeks following treatment. The feasibility and short-term safety of this technique are reviewed, with emphasis on the stereotactic planning considerations, such as mediastinal organ movement and radiation tolerance.
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Affiliation(s)
- Scott G Soltys
- Department of Radiation Oncology, Stanford University Medical Center.
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Anderson P, Aguilera D, Pearson M, Woo S. Outpatient Chemotherapy plus Radiotherapy in Sarcomas: Improving Cancer Control with Radiosensitizing Agents. Cancer Control 2008; 15:38-46. [DOI: 10.1177/107327480801500105] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Cancer control by radiotherapy (RT) can be improved with concurrent chemotherapy. Outpatient strategies for sarcomas that combine chemotherapy and RT are possible since supportive care and RT techniques have improved. Methods The current status of non-anthracycline chemotherapy in combination with radiation for high-risk sarcoma is reviewed. Results Ifosfamide with mesna and newer activated ifosfamide agents (ZIO-201 and glufosfamide) have high potential to improve sarcoma cancer control. In Ewing's sarcoma and osteosarcoma, high-dose ifosfamide with mesna (2.8 g/m2/day of each x 5 days; mesna day 6) can be safely given to outpatients using continuous infusion. Reducing ifosfamide nephrotoxicity and central nervous system side effects are discussed. Other outpatient radiosensitization regimens include gemcitabine (600–1000 mg/m2/dose IV over 1 hour weekly x 2–3 doses), temozolomide (75 mg/m2/daily x 3–6 weeks), or temozolomide (100 mg/m2/dose daily x 5) + irinotecan (10 mg/m2/dose daily x 5 x 2 weeks). In osteosarcoma with osteoblastic metastases on bone scan, samarium (1 mCi/kg; day 3 of RT) and gemcitabine (600 mg/m2 IV over 1 hour day 9 of RT) is a radiosensitization strategy. Future drugs for radiosensitization include beta-D-glucose targeted activated ifosfamide (glufosfamide) and sapacitabine, an oral nucleoside with in vitro activity against solid tumors including sarcomas. Conclusions The potential to treat major causes of sarcoma treatment failure (local recurrence and distant metastases) with concurrent chemotherapy during radiation should be considered in high-grade sarcomas.
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Affiliation(s)
- Pete Anderson
- Departments of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Dolly Aguilera
- Departments of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Margaret Pearson
- Departments of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Shaio Woo
- Radiation Oncology at The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Tan DHS, Bunce PE, Liles WC, Gold WL. Gemcitabine-related "pseudocellulitis": report of 2 cases and review of the literature. Clin Infect Dis 2007; 45:e72-6. [PMID: 17682983 DOI: 10.1086/520684] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 04/25/2007] [Indexed: 11/03/2022] Open
Abstract
Gemcitabine is a chemotherapeutic agent whose cutaneous toxicities are easily mistaken for infections. We describe 2 patients, 1 with gemcitabine-induced radiation recall dermatitis and 1 with gemcitabine-related erysipeloid reaction, who received misdiagnoses of infectious cellulitis and were given empirical antibiotics. Recognition of these syndromes is important to avoid unnecessary antibiotic use.
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Affiliation(s)
- Darrell H S Tan
- Division of Infectious Diseases, University Health Network, Toronto, ON.
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Caloglu M, Yurut-Caloglu V, Cosar-Alas R, Saynak M, Karagol H, Uzal C. An ambiguous phenomenon of radiation and drugs: recall reactions. Oncol Res Treat 2007; 30:209-14. [PMID: 17396045 DOI: 10.1159/000099632] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The term 'radiation recall' describes an acute inflammatory reaction in previously irradiated areas after the administration of certain inciting systemic agents. It was first described in 1959 by D'Angio that dermatitis is related to the application of actinomycin D on the skin. Though this reaction occurs frequently on the skin, it may also be seen in the oral mucosa, the larynx, esophagus, small intestine, lungs, muscle tissue, and brain. Most drugs associated with recall reactions are cytotoxics, however, several other drugs may also elicit the phenomenon. Although this phenomenon is well known, its etiology is not understood. Radiation recall reactions are generally associated with megavoltage radiotherapy. The time interval between the completion of radiotherapy and the recall reaction ranges from days to years. The recall reaction occurs on average 8 days (3 days to 2 months) after the application of the promoting agent. Although no standard treatment exists, some authors suggest discontinuation of the inciting drug and the use of corticosteroids or nonsteroidal anti-inflammatory agents.
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Affiliation(s)
- Murat Caloglu
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.
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Valencak J, Troch M, Raderer M. Cutaneous Recall Phenomenon at the Site of Previous Doxorubicin Extravasation After Second-Line Chemotherapy. ACTA ACUST UNITED AC 2007; 99:177-8. [PMID: 17228004 DOI: 10.1093/jnci/djk027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mornex F, Girard N. Gemcitabine and radiation therapy in non-small cell lung cancer: state of the art. Ann Oncol 2006; 17:1743-7. [PMID: 16766586 DOI: 10.1093/annonc/mdl117] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Stage III non-small cell lung cancer (NSCLC) treatment is evolving. There are several choices available regarding which chemotherapy to use and how to optimally combine them with radiotherapy. Gemcitabine (Gemzar, Eli Lilly and Company, Indianapolis, USA) is a chemotherapeutic agent with activity in NSCLC, and preclinical studies have shown that gemcitabine is a potent radiosensitizer. These two characteristics make gemcitabine a potential option when treating patients with stage III NSCLC. This review article describes the efficacy and tolerance of gemcitabine when combined with radiation in those patients. Gemcitabine used concurrently with radiation, as an induction regimen before radiation, and as a consolidation regimen after radiation is reviewed.
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Affiliation(s)
- F Mornex
- Department of Radiotherapy-Oncology, Centre Hospitalier Lyon-Sud, Lyon, France.
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Affiliation(s)
- Sarah Squire
- Brown Medical School, Providence, RI 02912, USA.
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Results of a Phase I Dose-Escalation Study Using Single-Fraction Stereotactic Radiotherapy for Lung Tumors. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)30409-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Results of a Phase I Dose-Escalation Study Using Single-Fraction Stereotactic Radiotherapy for Lung Tumors. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200610000-00008] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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