ABSTRACT
Proton beam therapy (PBT) is one of the advances in radiotherapy techniques, which enables dose escalation with lower probability of radiation-induced liver or gastrointestinal injuries. However, the chest wall proximal to the tumor can be affected by high dose irradiation. Here, we report on a 58-year-old male patient who presented with huge hepatocellular carcinoma, received treatment with transarterial chemoembolization and PBT, and developed severe chest wall pain due to radiation-induced myositis. The patient's symptoms were controlled by oral steroids.
Subject(s)
Humans , Male , Middle Aged , Carcinoma, Hepatocellular , Liver , Myositis , Proton Therapy , Protons , Radiotherapy , Steroids , Thoracic WallABSTRACT
Radiation recall dermatitis (RRD) is the appearance of skin reactions in previously irradiated skin which is triggered by the administration of certain drugs. Surgery, chemotherapy, and radiotherapy are the mainstay of treatment in breast cancer. RRD induced by trastuzumab has been rarely reported in India. This is a case report of a 56-year-old woman presented to the medical oncology outpatient department of our hospital with breast lump, and she was diagnosed to have human epidermal growth factor receptor 2 (HER-2/neu) positive invasive ductal carcinoma of left breast of stage T2N3cM0. She was treated with neoadjuvant chemotherapy, and she underwent modified radical mastectomy with axillary lymph node dissection. The treating oncologist was planned to start on adjuvant chemotherapy with injection trastuzumab for every four weeks, for 15 cycles. Patient received first dose of injection trastuzumab (450 mg) intravenously in the right (contralateral) arm and developed painful, swollen, erythematous blisters, and maculopapular rashes following the sharp linear borders of her previous radiation fields. She was reviewed by the medical oncologist and diagnosed as a rare case of RRD and treated with topical betamethasone cream. Causality assessment for RRD to trastuzumab was done using Naranjo and WHO-UMC scale and found to be in the category of probable and probable/ likely respectively.
ABSTRACT
Sorafenib is widely used for unresectable and metastatic hepatocellular carcinomas. Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin that occurs after the administration of certain drugs. RRD after sorafenib treatment is rare; five cases have been reported thus far. We describe a 44-year-old man irradiated for chest wall bone metastasis from hepatocellular carcinoma. Eight days after radiotherapy completion, systemic therapy for metastatic hepatocellular carcinoma was initiated with sorafenib treatment. Eleven days after starting sorafenib, the patient complained of erythematous rash with pruritus in the chest wall, in a location consistent with the previous radiation field. Sorafenib was continued at the same dose, despite the RRD. The skin reaction subsided over the next 2 weeks without any medical intervention.
Subject(s)
Adult , Humans , Carcinoma, Hepatocellular , Exanthema , Neoplasm Metastasis , Pruritus , Radiodermatitis , Radiotherapy , Skin , Thoracic WallABSTRACT
Sorafenib is widely used for unresectable and metastatic hepatocellular carcinomas. Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin that occurs after the administration of certain drugs. RRD after sorafenib treatment is rare; five cases have been reported thus far. We describe a 44-year-old man irradiated for chest wall bone metastasis from hepatocellular carcinoma. Eight days after radiotherapy completion, systemic therapy for metastatic hepatocellular carcinoma was initiated with sorafenib treatment. Eleven days after starting sorafenib, the patient complained of erythematous rash with pruritus in the chest wall, in a location consistent with the previous radiation field. Sorafenib was continued at the same dose, despite the RRD. The skin reaction subsided over the next 2 weeks without any medical intervention.
Subject(s)
Adult , Humans , Carcinoma, Hepatocellular , Exanthema , Neoplasm Metastasis , Pruritus , Radiodermatitis , Radiotherapy , Skin , Thoracic WallABSTRACT
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.
Subject(s)
Humans , Adrenal Cortex Hormones , Biomarkers, Tumor , CA-19-9 Antigen , Chemotherapy, Adjuvant , Inflammation , Pancreatic Neoplasms , RadiodermatitisABSTRACT
Se presenta un caso de reacción evocadora de radiación (RER) en una paciente de 37 años con cáncer de mama estadio IIIB, que realizó 6 ciclos de quimioterapia con epidoxorubicina y docetaxel, terapia radiante y trastuzumab. Diez días después definalizada la radioterapia, desarrolló una dermatosis ampollar en la mama irradiada, coincidiendo con un ciclo de tratuzumab. El trastuzumab, anticuerpo monoclonal humanizado contra el receptor HER2, fue aprobado en 1998 por la FDA como primera línea de tratamiento paliativo para el cáncer de mama avanzado con receptores HER2 positivos y, como terapia adyuvante, en 2006. Existen pocos casos de RER por trastuzumab comunicados hasta la fecha.
A 37-year-old female patient with radiation recall dermatitis (RRD) is reported. She held 6 cycles of chemotherapy with epidoxorubicin and docetaxel, radiant therapy and trastuzumab due to stage IIIB breast cancer. Ten days after finishing radiation therapy, she developed a blistering dermatitis on irradiated breast. Trastuzumab, a humanized monoclonal antibody against the HER2 receptor, was approved in 1998 by the FDA as a first-line palliative treatment for advanced breast cancer with positive HER2 receptors and, as adjuvant therapy, in 2006. There are only few cases reported of RRD by trastuzumab up to date.
Subject(s)
Humans , Female , Adult , Radiation , Radiotherapy/adverse effects , Biopsy , Breast Neoplasms , SkinABSTRACT
Tamoxifen and radiotherapy are used in breast cancer treatment worldwide. Radiation recall dermatitis (RRD), induced by tamoxifen, has been rarely reported. Herein, we report a RRD case induced by tamoxifen. A 47-year-old woman had a right quadrantectomy and an axillary lymph node dissection due to breast cancer. The tumor was staged pT2N0; it was hormone receptor positive, and human epidermal growth factor receptor 2 negative. The patient received adjuvant chemotherapy followed by tamoxifen and radiotherapy. After 22 months of tamoxifen, the patient developed a localized heating sensation, tenderness, edema, and redness at the irradiated area of the right breast. The symptoms improved within 1 week without treatment. Three weeks later, however, the patient developed similar symptoms in the same area of the breast. She continued tamoxifen before and during dermatitis, and symptoms resolved within 1 week.
Subject(s)
Female , Humans , Middle Aged , Breast , Breast Neoplasms , Chemotherapy, Adjuvant , Dermatitis , Edema , Heating , Hot Temperature , Lymph Node Excision , Radiodermatitis , Radiotherapy , ErbB Receptors , Sensation , TamoxifenABSTRACT
Sorafenib is a multi-targeted kinase inhibitor, which is the current standard treatment for advanced hepatocellular carcinoma (HCC). Only one case of radiation recall dermatitis (RRD) associated with sorafenib has been reported so far. Our patient with recurrent HCC was treated with palliative radiotherapy (RT) for the chest wall mass. Sorafenib at 400 mg twice daily was begun on the day following RT. On the 14th day post-RT, an erythematous patch was observed on right chest wall which matched area previously irradiated. It was consistent with RRD. Ten days later, a disseminated exanthematous rash and severe pruritus occurred. Sorafenib was stopped and an oral antihistamine was prescribed to relieve symptoms. At the 1-week follow-up after the cessation of sorafenib, all symptoms were resolved. Physicians should be alert to this recall phenomenon as it can occur both in the skin and elsewhere and the occurrence of RRD may be unpredictable.
Subject(s)
Humans , Carcinoma, Hepatocellular , Exanthema , Follow-Up Studies , Niacinamide , Phenylurea Compounds , Phosphotransferases , Pruritus , Radiodermatitis , Skin , Thoracic WallABSTRACT
Radiation recall dermatitis refers to an acute inflammatory reaction in a previously irradiated field triggered by the administration of certain drugs days to years after the exposure to radiation. Gefitinib is an epidermal growth factor receptor tyrosine kinase inhibitor and is an effective treatment for patients with advanced stage of non small cell lung cancer (NSCLC). Here, we report a rare case of gefitinib induced radiation recall dermatitis. A 52-year-old woman with a metastatic NSCLC had received a palliative radiation therapy of 20 cGy on spine metastasis area (C6-T6). After 24 days of receiving radiation therapy, she had started to take gefitinib. Eight months after taking drug, pain, swelling and erythema of skin were occurred on previously irradiated field. These symptoms were resolved after the cessation of gefitinib for 6 days and the topical use of steroid.
Subject(s)
Female , Humans , Middle Aged , Erythema , Lung Neoplasms , Neoplasm Metastasis , Protein-Tyrosine Kinases , Radiodermatitis , ErbB Receptors , Skin , Small Cell Lung Carcinoma , SpineABSTRACT
Radiation recall dermatitis refers to an acute inflammatory reaction in a previously irradiated field triggered by the administration of certain drugs days to years after the exposure to radiation. Gefitinib is an epidermal growth factor receptor tyrosine kinase inhibitor and is an effective treatment for patients with advanced stage of non small cell lung cancer (NSCLC). Here, we report a rare case of gefitinib induced radiation recall dermatitis. A 52-year-old woman with a metastatic NSCLC had received a palliative radiation therapy of 20 cGy on spine metastasis area (C6-T6). After 24 days of receiving radiation therapy, she had started to take gefitinib. Eight months after taking drug, pain, swelling and erythema of skin were occurred on previously irradiated field. These symptoms were resolved after the cessation of gefitinib for 6 days and the topical use of steroid.
Subject(s)
Female , Humans , Middle Aged , Erythema , Lung Neoplasms , Neoplasm Metastasis , Protein-Tyrosine Kinases , Radiodermatitis , ErbB Receptors , Skin , Small Cell Lung Carcinoma , SpineABSTRACT
Radiation recall phenomenon is an inflammatory reaction which occurs at a previously irradiated area after the administration of causative agents, especially anticancer drugs. Radiation recall mostly involves skin and rarely affects internal organs. We, hereby, report a rare case of radiation recall myositis. A 51-years-old man visited the hospital due to pain and weakness of the left thigh. He had been diagnosed with a skin metastasis of pancreatic adenocarcinoma, at the left thigh and treated with radiotherapy and subsequent combination chemotherapy of 5-FU and cisplatin. After the 5th cycle of chemotherapy, the patient developed pain and weakness localized at the previous radiation field. An MRI revealed myositis of left gluteus medius muscle. Muscle biopsy showed no malignant cells or signs of infection. He was diagnosed as having radiation recall myositis and treated with steroid and NSAID. Soon after, pain and weakness gradually improved. Although rare, a possibility of radiation recall myositis should be considered when a patient with history of radiotherapy has a myopathy.
Subject(s)
Humans , Adenocarcinoma , Biopsy , Cisplatin , Drug Therapy, Combination , Fluorouracil , Muscles , Muscular Diseases , Myositis , Neoplasm Metastasis , Skin , ThighABSTRACT
Erlotinib (Tarceva(R)) is a new anti-cancer agent that acts by inhibiting epidermal growth factor receptor (EGFR) signal transduction. It is currently used in the treatment of advanced stage non-small cell lung cancer and pancreatic cancer. A patient consulted our clinic and she had erythematous patches and vesicles on the submandibular area. She had taken erlotinib for the treatment of recurred lung cancer for 2 weeks. We report here on a case of radiation recall dermatitis that was induced by erlotinib in a 69-year-old woman who was previously irradiated on her submandibular area.
Subject(s)
Aged , Female , Humans , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Pancreatic Neoplasms , Quinazolines , Radiodermatitis , ErbB Receptors , Signal Transduction , Erlotinib HydrochlorideABSTRACT
A sixty-seven year old male was treated with palliative radiation therapy due to his right hip joint pain, and the pain was caused by osteolytic right acetabular metastasis. He underwent 30 Gy irradiation and then his painful symptoms disappeared at the 1 month follow-up after radiation therapy. He next received received systemic chemotherapy with 3 cycles of gemcitabine plus cisplatin and then 6 cycles of docetaxel. He visited the emergency room at the time of 4 months after the completion of radiation therapy with complaints of relapsed right hip joint pain. On MRI, localized muscular swelling with infiltration and without contrast-enhancement was seen within the previous radiation field, and the clinical impression was radiation-recall myositis. We provided symptomatic treatment and his right hip joint pain with disability disappeared 2 weeks after the treatment. No relapse of the right hip joint pain developed during the patient's survival period. We experienced a case of radiation-recall myositis that was related to gemcitabine use after radiation therapy
Subject(s)
Humans , Male , Carcinoma, Non-Small-Cell Lung , Cisplatin , Deoxycytidine , Emergencies , Follow-Up Studies , Hip Joint , Lung Neoplasms , Myositis , Neoplasm Metastasis , Recurrence , TaxoidsABSTRACT
Radiation recall dermatitis is the development of an inflammatory reaction in the previously irradiated area, precipitated by the administration of certain drugs. A 54-year-old man was diagnosed with follicular lymphoma, grade 3 and stage 3. Cancer recurred two years after complete remission obtained by chemotherapy and radiotherapy. Therefore, he was again treated with fludarabine and mitoxantrone for five cycles, then underwent an allogeneic peripheral blood stem cell transplantation (PBSCT). The patient started to receive methotrexate the day after PBSCT. On the day of the first methotrexate administration, the patient developed erythematous erosions with pruritus and severe pain in the previously irradiated area. The skin lesion resolved almost completely after dressing with topical antibiotics and wet dressing with 0.3% aluminium solution for 2 weeks. We report a case of radiation recall dermatitis in a patient with follicular lymphoma that occurred after receiving methotrexate.
Subject(s)
Humans , Middle Aged , Anti-Bacterial Agents , Bandages , Drug Therapy , Lymphoma, Follicular , Methotrexate , Mitoxantrone , Peripheral Blood Stem Cell Transplantation , Pruritus , Radiodermatitis , Radiotherapy , SkinABSTRACT
Multiple modality treatment has been adapted for the treatment of various cancers,the outcome has been dramatically improved,but some of unique side effects due to the modalities like chemotherapy combined with radiotherapy have been observed in the clinic. Radiation recall dermatitis(RRD) is one of the side effects. In this paper,the etiology,clinical features,diagnosis,treatment and related factors of the radiation recall dermatitis are discussed.
ABSTRACT
Radiation recall dermatitis gap (RRD) is the development of an inflammatory reaction throughout a previously irradiated area, precipitated by the administration of certain drugs. Usually chemotherapeutic agents have been associated with RRD, but other drugs reported include tamoxifen, interferon alfa-2b, simvastatin, and antituberculous drugs. We present a case of RRD after chemotherapy with letrozol (Femara(R)). Letrozol is a third generation aromatase inhibitor, which acts as an anti-estrogen agent. This is the first reported case of RRD triggered by letrozol.
Subject(s)
Aromatase , Drug Therapy , Interferons , Radiodermatitis , Simvastatin , TamoxifenABSTRACT
Radiation recall dermatitis is a rare skin reaction, occurring subsequent to drug administration, and has all the clinical signs of inflammation, which develop in a previously irradiated area, days to years after exposure to ionizing radiation. A 41-year-old woman was diagnosed with Kaposi sarcoma. The patient was treated by radiotherapy, followed by a 1st chemotherapy session with doxorubicin and ifosfamide, 20 days after the radiotherapy. However, the patient developed erythema of the skin, accompanied by pruritus and pain in the previously irradiated area, 3 to 4 days after the chemotherapy. The erythema resolved almost completely after systemic and topical steroid therapy. The patient received a 2nd chemotherapy session with the same regimen, but there was no recurrence of radiation recall dermatitis. We report a case of an uncommon skin reaction after chemotherapy in a patient with kaposi sarcoma, which was identified as radiation recall dermatitis.
Subject(s)
Adult , Female , Humans , Doxorubicin , Drug Therapy , Erythema , Ifosfamide , Inflammation , Pruritus , Radiation, Ionizing , Radiodermatitis , Radiotherapy , Recurrence , Sarcoma, Kaposi , SkinABSTRACT
Radiation recall dermatitis is a rare skin reaction, occurring subsequent to drug administration, and has all the clinical signs of inflammation, which develop in a previously irradiated area, days to years after exposure to ionizing radiation. A 41-year-old woman was diagnosed with Kaposi sarcoma. The patient was treated by radiotherapy, followed by a 1st chemotherapy session with doxorubicin and ifosfamide, 20 days after the radiotherapy. However, the patient developed erythema of the skin, accompanied by pruritus and pain in the previously irradiated area, 3 to 4 days after the chemotherapy. The erythema resolved almost completely after systemic and topical steroid therapy. The patient received a 2nd chemotherapy session with the same regimen, but there was no recurrence of radiation recall dermatitis. We report a case of an uncommon skin reaction after chemotherapy in a patient with kaposi sarcoma, which was identified as radiation recall dermatitis.
Subject(s)
Adult , Female , Humans , Doxorubicin , Drug Therapy , Erythema , Ifosfamide , Inflammation , Pruritus , Radiation, Ionizing , Radiodermatitis , Radiotherapy , Recurrence , Sarcoma, Kaposi , SkinABSTRACT
A radiation recall reaction refers to an inflammatory reaction at previous irradiated areas subsequent to the administration of a variety of pharmacological agents. The skin is the major site of radiation recall reactons with the muscle and internal organs being less commonly affected. These reactions usually occur days to weeks after exposure to the causative agents. We report a case of gemcitabine-induced radiation recall dermato-myositis the developed in a female patient with a metastatic non-small cell lung cancer. She had received a palliative radiation therapy of 3900 cGy to the metastatic lesion on the femur shaft prior to chemotherapy. The pain, swelling and erythema of the left thigh resolved after the cessation of gemcitabine and the use of a systemic steroid.
Subject(s)
Female , Humans , Carcinoma, Non-Small-Cell Lung , Drug Therapy , Erythema , Femur , Lung Neoplasms , Radiodermatitis , Skin , ThighABSTRACT
Radiation recall dermatitis is the development of an inflammatory reaction throughout an area previously irradiated, precipitated by the administration of certain drugs. A 48-year-old woman was postoperatively treated with radiotherapy for synovial sarcoma on her left hip. The total dose given was 46 Gy by 2 Gy per day. After 2 weeks, she underwent her 1st cyclophosphamide, dacarbazine, doxorubicin (MAID) chemotherapy teatment. After 3 days, erythema began to develop in the previously irradiated area and during the following 7 days a severe skin and subcutaneous reaction occurred. After 3 weeks, the skin lesion was completely healed and thereafter no further "recall" occurred despite a 2nd MAID chemotherapy treatment.