Toxic epidermal necrolysis after cranial radiotherapy and phenytoin treatment.

BACKGROUND: There are few reports about Stevens-Johnson syndrome, a bullous form of erythema multiforme, that can develop in patients treated with cranial irradiation and antiepileptic drugs, especially with phenytoin. We present a patient who developed toxic epidermal necrolysis, a rare and severe form of Stevens-Johnson syndrome, during cranial radiotherapy and phenytoin treatment. CASE REPORT: A 65-year-old male patient with stage IIIB non-small cell lung carcinoma developed a brain metastasis. The patient was treated with phenytoin and dexamethasone. Palliative total cranial irradiation was performed. On the 23rd day of phenytoin administration, erythema and edema in the radiotherapy area and lips, as well as widespread maculopapular eruptions and rashes in the upper thoracic area were observed. The dermal lesions progressed to bullae and subsequently toxic epidermal necrolysis covering 70% of the whole body surface developed. The patient died within 15 days of appearance of the lesions due to secondary infections, despite supportive and symptomatic treatment. CONCLUSION: Although toxic epidermal necrolysis is a rare toxicity it must always be considered during cranial irradiation and antiepileptic prophylaxis.

Radiotherapy for benign diseases: a retrospective analysis.

PURPOSE: Radiotherapy of benign diseases has become a frequently discussed subject while there are neither generally accepted guidelines about the indications of radiotherapy, doses and fractionation schedules nor adequate data about the risks and the effectiveness of irradiation. We have retrospectively analyzed the patients who were irradiated for benign diseases in our department. PATIENTS AND METHODS: During the period 1978-1997, a total of 262 patients were irradiated for benign diseases. Megavoltage equipment was used for irradiation of 253 patients, while the remaining 9 patients were irradiated by orthovoltage equipments. The diseases were grouped in 5 categories, and the distribution of the patients referred and irradiated per year was analyzed. Radiotherapy doses, fractionation, response rates and follow-up were evaluated. RESULTS: The number of irradiated patients has been increasing since the 1990's. The most common indication for irradiation was Graves' ophthalmopathy and the incidence of this group has increased after 1992. On the other hand, the number of patients irradiated for soft tissue, bone and skin diseases, except aggressive fibromatosis, has declined in the past 15 years. Response rates were more than 60% for most of the diseases. The patients' follow-up ranged between 1 and 156 months (median 4 months), but it was rather short for most of them. CONCLUSION: We observed common problems about the irradiation of benign diseases such as variations on the accepted indications, the treatment schedules and followup.