Radiation recall dermatitis with azithromycin

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.     

Radiation recall dermatitis with pemetrexed

Pemetrexed has recently been approved for use in combination with cisplatin as first-line chemotherapy for malignant pleural mesothelioma (MPM). Radiation therapy is frequently administered to the thoracic orifices and no data are available about the interactions between radiotherapy and pemetrexed. We report the first case of radiation recall dermatitis occurring after pemetrexed chemotherapy in a patient with MPM previously treated with radiation therapy to the thoracoscopy and drainage orifices. The patient received chemotherapy with pemetrexed and cisplatin 19 days after completion of chest wall radiation therapy delivering 21 gray in 3 days. Conventional premedication by folic acid and intramuscular administration of Vitamin B12 and prednisolone was correctly performed. Twelve days later, confluent erythematous and pruritus rash of the irradiated skin was observed. The toxicity grade of this lesion was evaluated at 2 according to the Acute Radiation Morbidity Scoring Criteria proposed by the Radiation Therapy Oncology Group. Pemetrexed challenge was performed without worsening of skin lesions. Three weeks later, skin cicatrisation was observed after a desquamative phase. Persistent hyperpigmentation was seen in the irradiated skin. Pemetrexed could also act as a radiosensitizing agent that should be used with care for several weeks after radiotherapy.     

Radiation recall dermatitis: A review of the literature

Purpose/ObjectivesRadiation recall dermatitis (RRD) is a skin reaction limited to an area of prior radiation triggered by the subsequent introduction of systemic therapy. To characterize RRD, we conducted a literature search, summarized RRD features, and compared the most common drug classes implicated in this phenomenon.Materials/MethodsPubMed, Embase, Scopus, Web of Science, and Cochrane DBSR databases were queried through July 1, 2019 using key words: radiation recall, RRD, and radiodermatitis (limited to humans and English language). Studies included case reports in which patients treated with radiotherapy were initiated on a new line of systemic therapy and subsequently developed a skin reaction in the irradiated area. RRD cases were organized by whether RRD occurred after a single drug or multiple drug administration.ResultsOne-hundred fifteen studies representing 129 RRD cases (96 single-drug RRD, 33 multi-drug) were included. Sixty-three drugs were associated with RRD. Docetaxel (22) and gemcitabine (18) were the two drugs most commonly associated with RRD. Breast cancer (69 cases) was the most commonly associated tumor type. For single-drug RRD, the median radiotherapy dose was 45.0 Gy (range, 30.0–63.2 Gy). The median time from radiotherapy to drug exposure, time from drug exposure to RRD and time to significant improvement was 8 weeks (range, 2–132 weeks), 5 days (range, 2–56 days), and 14 days (range, 7–49 days), respectively. Variables significantly associated with grade ≥2 toxicity were docetaxel (P = 0.04) and non-antifolate antimetabolite (P = 0.05). The only variable significantly associated with grade ≥3 toxicity was capecitabine (P = 0.04).ConclusionsRRD is a complex toxicity that can occur after a wide range of radiotherapy doses and many different systemic agents. Most commonly, it presents in patients diagnosed with breast cancer and after administration of a taxane or antimetabolite medication. RRD treatment generally consists of corticosteroids with consideration of antibiotics if superinfection is suspected. Drug re-challenge may be considered after RRD if the initial reaction was of mild intensity.     

Radiation recall dermatitis with cefotetan: a case study

Radiation recall dermatitis (RRD) is an inflammatory skin reaction that occurs in a previously irradiated body part following drug administration. This phenomenon may occur from days to years following exposure to ionizing radiation. The case of a 54-year-old Caucasian woman who was initially treated with external-beam radiation to the right thoracic region following the diagnosis of a poorly differentiated squamous cell carcinoma of the right lung is reported. She received four cycles of consolidated chemotherapy with docetaxel and carboplatin. Four months later, she was admitted to the hospital for acute cholecystitis and was placed on cefotetan. She developed a tender, erythematous rash on the posterior region of her right thorax 48 hours later. The drug was withdrawn, supportive care was instituted, and the patient subsequently improved. RRD should be suspected in patients who develop an erythematous rash in a previously irradiated region. To our knowledge this entity has not been associated with cefotetan previously.     

Radiation recall dermatitis in a patient treated with dacarbazine

Radiation recall describes an inflammatory reaction at a previously irradiated site associated with the use of chemotherapeutic agents. Dacarbazine, a tetrazine cytotoxic drug, has not been noted to cause this phenomenon. We report the case history of a 44-year-old female patient who developed a recall dermatitis due to dacarbazine in a site previously irradiated for the treatment of malignant melanoma. The skin erythema responded quickly to oral corticosteroid treatment. Further cycles of dacarbazine were facilitated with oral corticosteroid premedication. We conclude that dacarbazine should be considered as a potential cause of radiation recall dermatitis and that this can be managed and prevented with oral corticosteroids.     

Radiation recall dermatitis after docetaxel and external beam radiotherapy. Report of two cases and review of the literature]

Radiation recall refers to a tissue reaction produced by a chemotherapeutic agent in a previously irradiated field that would not occur in a nonirradiated field. Docetaxel is a member of the taxane group of antineoplastic agents that cause disruption of cell division by enhancing microtubule assembly and inhibiting tubulin depolymerisation. As well as in breast cancer and lung cancer treatment, its association in a chemoradiation planned treatment becomes frequent and effective. Most of radiation recall dermatitis (RDD) reported in literature concerned paclitaxel or other drugs. We report two particularly striking cases of RDD with docetaxel and radiotherapy. Even if etiology remains undetermined, a number of hypotheses can be formulated. Familiarity with this phenomenon and potential complications of chemotherapy following tumor irradiation may expedite early diagnosis and appropriate lifesaving treatment.     

Radiation recall dermatitis with gatifloxacin: a review of literature

Radiation recall dermatitis (RRD) is a hypersensitivity skin reaction at the previously irradiated site after the administration of certain pharmacologic agent, which recovers on stopping the medication. RRD is a well-recognized phenomenon with the use of chemotherapeutic agents; however, only a few cases have been reported with noncytotoxic antibiotics, despite their common use in patients with cancer. We report here a case of RRD with the use of gatifloxacin and describe the time dose factors of radiation exposure, characteristics of skin reactions, management and response and our reasons to label this case as RRD. We also discuss published work regarding proposed mechanisms, histological features, radiation dose threshold and response to rechallange with the RRD-triggering drug. If RRD is to be characterized unequivocally, all the potential areas of confusion must be clarified like radiosensitization, nonhealing of acute reactions and skin-related adverse effects of the RRD-triggering drug. With the same objective, we further discussed radiosensitization and photosensitizing potential of fluoroquinolones. Gatifloxacin, although devoid of photosensitivity reactions, may cause idiosyncratic hypersensitivity reaction to cause RRD and should be considered as a potential cause of RRD. Given the potential severity of the reaction and increasing use of gatifloxacin, it is important to be aware of this phenomenon.     

Radiation recall dermatitis: case report and review of the literature

"Radiation recall"-also called "radiation recall dermatitis"-has been defined as the "recalling" by skin of previous radiation exposure in response to the administration of certain response-inducing drugs. Although the phenomenon is relatively well known in the medical world, an exact cause has not been documented. Here, we report a rare occurrence of the radiation recall phenomenon in a breast cancer patient after palliative radiotherapy for bone, brain, and orbital metastases.     

Radiation recall dermatitis induced by methotrexate in a patient with Hodgkin's disease

Radiation recall dermatitis refers to an inflammatory skin reaction at a previously irradiated field subsequent to chemotherapy administration. A number of antineoplastic agents have been reported to cause this phenomenon. We observed radiation recall dermatitis in a patient with stage IV nodular sclerosing Hodgkin's disease after methotrexate therapy for acute graft-versus-host disease (GVHD) prophylaxis. The patient had previously undergone matched related bone marrow transplantation with busulfan and cyclophosphamide as a preparative regimen. Subsequently, she received cyclosporine and methotrexate for acute GVHD prophylaxis. Two areas of skin previously irradiated to 3,000 cGy developed radiation recall dermatitis after two doses of methotrexate given 2 days apart and exacerbated by the third and fourth doses. This reaction occurred 34 days after the last dose of radiation therapy (RT). We believe this is the first case of radiation recall dermatitis after methotrexate therapy. Given the increased use of methotrexate in several neoadjuvant and adjuvant protocols in association with RT, its potential to produce radiation recall reactions should be considered.     

Radiation recall dermatitis due to gemcitabine does not suggest the need to discontinue chemotherapy

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.     

药物引起放射治疗的回忆反应性皮炎

随着近年来恶性肿瘤综合治疗方案的广泛应用，使恶性肿瘤的治愈率有了显著的提高。与此同时，人们也越来越注意到一些联合治疗所引发的“独特的”毒副作用，其中非常罕见而又十分重要的就是回忆反应。本文重点介绍回忆反应中最常见的回忆反应性皮炎（radiation fecall dermatitiS，RRD），并试图剖析引起回忆反应性皮炎的病因、发病机制、临床特征、诊断及治疗，并描述影响RRD发生的相关因素如：放射剂量、诱发药物等。     

Radiation recall with anticancer agents

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.     

Radiation recall reaction following gemcitabine

A case of dermatitis and myositis in the upper thorax following administration of gemcitabine in a 65-year-old woman with metastatic non small cell lung cancer (NSCLC) is described. The reaction and time course suggest a radiation recall phenomenon. This report joins a small but increasing number of radiation recall events related to gemcitabine. The possibility of a radiation recall reaction should be borne in mind when a patient develops symptoms in a previously irradiated site without evidence of disease progression at that site. Cessation of the precipitating drug is the most important step in management and systemic steroids may hasten symptomatic relief.