Radiation-induced Myositis after Proton Beam Therapy to Huge Hepatocellular Carcinoma

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.

A new proposal for a clinical-oriented subclassifi-cation of baboon syndrome and a review of baboon syndrome.

Objective: To review baboon syndrome (BS). Data Sources: Date sources were obtained from PubMed and Google Scholar: Photographs of baboon syndrome were obtained from our patient. Study Selections: PubMed and Google Scholar were searched up to June 30, 2010. The search terms were “baboon syndrome”, “SDRIFE” and “thimerosal allergy”. Reverse references from relevant articles and Google Scholar were also used. As BS is a classical disease and cases of offending agents were relatively old, some references were more than five years old. In order to gather as many cases of offending agents as possible, more than 50 references were collected. Results and Conclusion: We divided BS into as 4 groups; classical baboon syndrome, topical drug-induced baboon syndrome, systemic drug-induced baboon syndrome and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). The pathomechanism of BS is still unknown. A delayed type of hypersensitivity reaction, a recall phenomenon, pharmacologic interaction with immune-receptors and anatomical factors may be involved in the causation of BS.