1
|
Ferdause J, Islam MA, Ahmed N, Kadir AKMS, Haque MA. Radiation recall dermatitis in HER 2 positive breast cancer patients triggered by trastuzumab: A rare case report and review of literature. Int J Surg Case Rep 2024; 120:109864. [PMID: 38852571 PMCID: PMC11220519 DOI: 10.1016/j.ijscr.2024.109864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Radiation recall dermatitis (RRD) is a localized drug-induced inflammatory skin reaction occurring exclusively in a previously irradiated site months to years after discontinuation of ionizing radiation. The symptoms of RRD can range from mild redness to extensive dermatitis. Antineoplastic drugs such as doxorubicin, docetaxel, paclitaxel, and gemcitabine are most commonly associated with radiation recall reactions. These reactions can also occur with antibiotics and anti-tubercular drugs. CASE PRESENTATION A 38-years-old woman with hormone receptor-negative, HER2-positive inflammatory breast cancer (right), clinical stage cT4dN1Mx, received neoadjuvant chemotherapy with AC > TH protocol at 3 weeks intervals (Anthracycline-Doxorubicin plus Cyclophosphamide X 4 cycles, then docetaxel plus Trastuzumab X 4 cycles) followed by modified radical mastectomy followed by adjuvant locoregional radiotherapy. She received the 5th cycle and 6th cycle trastuzumab monotherapy just before the start of surgery and radiotherapy, respectively. After 1 month of completion of radiotherapy, during her seventh cycle of Trastuzumab monotherapy, she developed mild edema with erythematous change over the previously irradiated area with fever. A skin biopsy was taken to exclude any recurrence; however, no evidence of malignancy was found. CLINICAL DISCUSSION We diagnosed it as a case of RRD. We managed her conservatively. Later, she was rechallenged with the same dose in subsequent cycles with systemic steroid coverage, which she tolerated very well, except for the reappearance of mild erythema following each cycle of maintenance dose of Trastuzumab. CONCLUSION Radiation recall dermatitis is an extremely rare phenomenon; hence, an acquaintance of clinicians with this rare entity is essential for timely diagnosis and appropriate management.
Collapse
Affiliation(s)
- Jannatul Ferdause
- Department of Radiation Oncology, Ahsania Mission Cancer and General Hospital, Dhaka, Bangladesh
| | - Md Ariful Islam
- Department of Histopathology, Ahsania Mission Cancer and General Hospital, Dhaka, Bangladesh
| | - Nusrat Ahmed
- Ahsania Mission Cancer and General Hospital, Dhaka, Bangladesh
| | | | - Md Ariful Haque
- Department of Public Health, Atish Dipankar University of Science and Technology, Dhaka, Bangladesh; Voice of Doctors Research School, Dhaka, Bangladesh; Department of Orthopaedic Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, China.
| |
Collapse
|
2
|
Heisler E, Tunnage I, Growdon W. Radiation recall dermatitis during treatment of endometrial cancer with pembrolizumab plus lenvatinib: A case report. Gynecol Oncol Rep 2023; 48:101239. [PMID: 37533427 PMCID: PMC10391910 DOI: 10.1016/j.gore.2023.101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 08/04/2023] Open
Abstract
Radiation Recall encompasses an array of inflammatory reactions, most commonly dermatitis, that occurs in response to a systemic medication with distribution in a previously irradiated field. While historically cytotoxic chemotherapy was a major culprit, this case report describes radiation recall dermatitis in response to pembrolizumab and lenvatinib in a 62-year old female with ongoing advanced endometrial cancer and history of breast cancer. Discontinuation of lenvatinib alone lead to complete resolution of the dermatitis, and she ultimately resumed her previous lenvatinib dose without recurrent symptoms. This case represents an important possible adverse effect of a commonly used targeted therapy, particularly in a population likely to have a history of prior radiation exposure.
Collapse
Affiliation(s)
- Elise Heisler
- Department of Obstetrics and Gynecology, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA
| | - Irina Tunnage
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA
| | - Whitfield Growdon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA
| |
Collapse
|
3
|
Bhangoo RS, Cheng TW, Petersen MM, Thorpe CS, DeWees TA, Anderson JD, Vargas CE, Patel SH, Halyard MY, Schild SE, Wong WW. Radiation recall dermatitis: A review of the literature. Semin Oncol 2022; 49:152-159. [DOI: 10.1053/j.seminoncol.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2021] [Accepted: 04/01/2022] [Indexed: 12/28/2022]
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Sweren E, Aravind P, Dembinski R, Klein C, Habibi M, Kerns ML. Radiation recall dermatitis following letrozole administration in patient with a remote history of radiation therapy. NPJ Breast Cancer 2021; 7:62. [PMID: 34039983 PMCID: PMC8155087 DOI: 10.1038/s41523-021-00271-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/19/2021] [Indexed: 11/29/2022] Open
Abstract
We report the case of letrozole-induced radiation recall dermatitis (RRD) in a patient with a remote history of radiation therapy. There is only one previously known case of RRD triggered by letrozole in a patient with a recent (<3 month) history of radiation. Previously, only four other cases of aromatase-inhibitor-induced RRD have been reported. This case is significant for cancer care teams considering personalized treatments. In addition, improved long-term outcomes in cancer patients may lead to increases in and underdiagnoses of RRD. Likewise, RRD is patient specific, exacerbating health concerns, and can be difficult to recognize without proper awareness, documentation, and classification of triggering drugs. The authors hope to address these issues in this report.
Collapse
Affiliation(s)
- Evan Sweren
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pathik Aravind
- Department of Surgery, Johns Hopkins Hospital, Bayview Campus, Baltimore, MD, USA
| | - Robert Dembinski
- Department of Surgery, Johns Hopkins Hospital, Bayview Campus, Baltimore, MD, USA
| | - Catherine Klein
- Department of Surgery, Johns Hopkins Hospital, Bayview Campus, Baltimore, MD, USA
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins Hospital, Bayview Campus, Baltimore, MD, USA
| | - Michelle L Kerns
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
6
|
Mandal A, Singh P, Tandon S, Singh D. “Radiation Recall Phenomenon” with Novel Cytotoxic Agents: An Emerging Trend in the Last Decade. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1729729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractRadiation recall phenomenon (RRP) is an acute inflammatory reaction manifested in the previously irradiated tissues after the administration of various pharmacologic compounds. While skin manifestations are the most common clinical features, patients may also present with visceral recall events including pneumonitis, hematuria, myopathy, and mucositis if any particular organ was exposed to the prior radiation portals. This article has reviewed the published case reports, case series, abstracts, and poster presentations in the past 10 years in any language on RRP caused by various novel cytotoxic drugs including immunotherapies, molecularly targeted agents, and unconventional chemotherapies. We retrieved the data through the literature search of MEDLINE and PubMed using the keywords “radiation,” “recall,” “targeted therapy,” and “immunotherapy,” and references identified in retrieved articles were also used for further search of the literature. With the increasing use of unconventional, novel cytotoxic agents and targeted molecules, concurrent or sequentially with radiation, we expect more incidences of RRP in future that may present with either dermatological or visceral recall reactions.
Collapse
Affiliation(s)
- Avik Mandal
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Pritanjali Singh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Dharmendra Singh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, Bihar, India
| |
Collapse
|
7
|
Bullous pemphigoid development during the course of breast cancer: a radiation induced or a radiation recall dermatitis? JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Bullous pemphigoid (BP) is the most common autoimmune bullous disease, which is usually seen in older ages. Rarely, radiotherapy (RT) has been reported as a localised trigger factor for BP.Case:We present a case of a 64-year-old woman who underwent radical mastectomy and radiation therapy for breast cancer. Two months after the completion of RT with adjuvant Trastuzumab, a BP eruption developed in the irradiated area, spreading thereafter to other skin areas. The patient was treated with oral corticosteroids and the lesions evolved favourably.Conclusion:This case demonstrates a relatively benign skin reaction that could develop during the course of cancer treatment, which required co-management by oncologists, pathologists and dermatologists.
Collapse
|
8
|
Gutkin PM, Fernandez‐Pol S, Horst KC. Erythema of the skin after breast radiotherapy: It is not always recurrence. Int Wound J 2020; 17:910-915. [PMID: 32227450 PMCID: PMC7948620 DOI: 10.1111/iwj.13350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022] Open
Abstract
Recurrence of breast cancer is a predominant fear for patients who were treated for breast cancer. Acute and late dermatologic effects of radiotherapy are not uncommon and could have similar characteristics to breast cancer recurrence. Thus, it is important to highlight key differences between the clinical and histologic presentations of radiation effects and recurrence. Herein, we present two patients who presented with late dermatologic effects of radiotherapy months to years after treatment, neither of whom had workup consistent with cancer recurrence. We provide clinical and microscopic descriptions of each case and provide a review to differentiate various dermatologic conditions. This report aims to outline potential late dermatologic effects of radiation treatment and emphasise that changes in the breast do not always signal breast cancer recurrence.
Collapse
Affiliation(s)
- Paulina M. Gutkin
- Department of Radiation OncologyStanford University School of MedicineStanfordCAUSA
| | | | - Kathleen C. Horst
- Department of Radiation OncologyStanford University School of MedicineStanfordCAUSA
| |
Collapse
|
9
|
Billena C, Padia S, O'Brien B, Knoble J, Gokhale A, Rajagopalan M. Radiation recall dermatitis after treatment of stage IV breast cancer with nivolumab: a case report. Immunotherapy 2020; 12:123-130. [PMID: 31992119 DOI: 10.2217/imt-2019-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Radiation recall dermatitis (RRD) is an uncommon dermatologic reaction provoked notably by chemotherapy in an area of skin irradiated weeks to years prior. We report a case of RRD with nivolumab in a woman with breast cancer. The patient was diagnosed with invasive ductal carcinoma of the left breast with an isolated spinal metastasis approached in an oligometastatic fashion with neoadjuvant chemotherapy, modified radical mastectomy and adjuvant radiotherapy. Unfortunately, after progression of bony metastases treated with radiotherapy, the patient received nivolumab and subsequently developed a rash corresponding to the adjuvant radiation field. This case highlights the unpredictable nature and characteristic rash of RRD. It is an important differential diagnosis for multidisciplinary teams who also see chemotherapy-induced dermatitis and immune-related adverse events.
Collapse
Affiliation(s)
- Cole Billena
- Department of Surgery, Mount Carmel Health System, Columbus, OH 43081, USA
| | - Shilpa Padia
- Department of Surgery, Mount Carmel Health System, Columbus, OH 43081, USA
| | - Bridget O'Brien
- Department of Surgery, Mount Carmel Health System, Columbus, OH 43081, USA
| | - Jeanna Knoble
- Department of Hematology, Oncology Zangmeister Cancer Center, Columbus, OH 43219, USA
| | - Abhay Gokhale
- Department of Radiation Oncology, Mount Carmel Health System, Columbus, OH 43081, USA
| | - Malolan Rajagopalan
- Department of Radiation Oncology, Mount Carmel Health System, Columbus, OH 43081, USA
| |
Collapse
|
10
|
Itamura H, Ohguri T, Yahara K, Nakahara S, Kakinouchi S, Morisaki T, Yatera K, Tanaka F, Korogi Y. Pembrolizumab-induced Radiation Recall Pneumonitis After the Resolution of Typical Asymptomatic Radiation Pneumonitis. J UOEH 2020; 42:261-266. [PMID: 32879190 DOI: 10.7888/juoeh.42.261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Radiation recall pneumonitis is a phenomenon in which a recall-triggering drug induces an acute inflammatory reaction in the lungs, corresponding to a previously irradiated area. Radiation recall reactions have been reported to occur following treatments with various cytotoxic anticancer agents and molecular-targeting drugs; however, only a few reports have described immune checkpoint inhibitor-induced radiation recall pneumonitis. We report a case of radiation recall pneumonitis induced by pembrolizumab in a patient with the postoperative local recurrence of non-small cell lung cancer. This case demonstrated that pembrolizumab might cause severe radiation recall pneumonitis, even after typical radiation pneumonitis has been resolved.
Collapse
Affiliation(s)
- Hirohide Itamura
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Takayuki Ohguri
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Katsuya Yahara
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Sota Nakahara
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Sho Kakinouchi
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Takahiro Morisaki
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Yukunori Korogi
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Japan
| |
Collapse
|
11
|
Emre S, Demirseren DD, Unal E, Sungu N. Recurrent radiation recall dermatitis triggered by radiological procedures in a patient with breast cancer. Australas J Dermatol 2019; 60:308-310. [PMID: 31012084 DOI: 10.1111/ajd.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/03/2019] [Indexed: 11/29/2022]
Abstract
Radiation recall dermatitis is an acute inflammatory reaction that occurs on previously irradiated skin by usage of chemotherapeutic agents and other triggering drugs. The recall reaction is usually associated with drugs but may also occur following ultraviolet radiation. We report a patient with radiation recall dermatitis, triggered after imaging procedures that involved radiation.
Collapse
Affiliation(s)
- Selma Emre
- Department of Dermatology, Medichal School, Yıldırım Beyazit University, Ankara, Turkey
| | | | - Esranur Unal
- Department of Dermatology, Medichal School, Yıldırım Beyazit University, Ankara, Turkey
| | - Nuran Sungu
- Department of Pathology, Medichal School, Yıldırım Beyazit University, Ankara, Turkey
| |
Collapse
|
12
|
Lockney DT, Jia AY, Lis E, Lockney NA, Liu C, Hopkins B, Higginson DS, Yamada Y, Laufer I, Bilsky M, Schmitt AM. Myositis following spine radiosurgery for metastatic disease: a case series. J Neurosurg Spine 2018; 28:416-421. [PMID: 29372858 DOI: 10.3171/2017.8.spine17162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Spinal stereotactic body radiation therapy (SBRT) has emerged as an attractive method to deliver high doses of radiation to oligometastatic spinal tumors with radioresistant histology. Because SBRT is a palliative therapy, attention to potential radiation toxicities is paramount when counseling patients. The objective of this study was to report radiation-induced myositis after SBRT, a previously undescribed complication. METHODS A total of 667 patients received 891 spine SBRT treatments (either 24 Gy in 1 fraction or 27 Gy in 3 fractions) from 2011 to 2016 and underwent retrospective review. Eleven patients were identified as having radiographic evidence of myositis following SBRT. Clinical and pathologic results were collected, including receipt of anti-vascular endothelial growth factor (VEGF) therapy, radiation dose, equivalent dose in 2-Gy fractions (EQD2), biologically effective dose (BED), and volume of muscle treated. Treatment toxicities were classified according to the Common Terminology Criteria for Adverse Events (CTCAE; version 4.03). Univariate statistical analyses were performed to evaluate the relationships between radiation fractionation schedule and myositis and between anti-VEGF therapy and myositis. RESULTS The cumulative incidence of myositis was 1.9% at 1 year. The median of the mean dose administered to muscle with myositis was 17.5 Gy. The median EQD2 was 55.1 Gy, and the median BED was 82.7 Gy. The median time to the development of clinical symptoms was 1.4 months, while the median time to imaging evidence was 4.7 months. Two patients (18.2%) had CTCAE grade 3 complications. Single-fraction spine SBRT (HR 4.5, 95% CI 1.2-16.9; p = 0.027) was associated with increased risk of developing myositis whereas receipt of anti-VEGF therapy was not (HR 2.2, 95% CI 0.6-7.1; p = 0.2). CONCLUSIONS Radiation myositis following spinal radiosurgery is a rare but important complication. Single-fraction treatment schedules may be associated with increased risk of myositis but should be validated in a larger series.
Collapse
Affiliation(s)
- Dennis T Lockney
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Angela Y Jia
- Departments of2Radiation Oncology.,3Department of Medicine, Weill Cornell Medical College, New York, New York
| | | | | | | | - Benjamin Hopkins
- 6Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York; and
| | | | | | - Ilya Laufer
- 6Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York; and
| | - Mark Bilsky
- 6Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York; and
| | | |
Collapse
|
13
|
Radiation recall dermatitis after docetaxel chemotherapy. Treatment by antioxidant ointment. Strahlenther Onkol 2014; 190:491-3. [PMID: 24615187 DOI: 10.1007/s00066-014-0609-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/18/2013] [Indexed: 11/26/2022]
Abstract
Radiation recall dermatitis (RRD) is an acute skin toxicity caused by different anticancer or antibiotic drugs within a former completely healed irradiation field. Predictive factors for RRD are not known and its mechanisms are not completely understood. A case of RRD induced by docetaxel and successfully treated by an antioxidant ointment (Mapisal(®)) is presented here. Such an ointment might be useful not only in RRD therapy, but also in the treatment of high-grade dermatitis induced by radiotherapy and thus may contribute to the improvement of patients' quality of life and to the scheduled completion of cancer therapies.
Collapse
|