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Radiation Recall Pneumonitis: A Rare Syndrome That Should Be Recognized. Cancers (Basel) 2022; 14:cancers14194642. [PMID: 36230564 PMCID: PMC9563843 DOI: 10.3390/cancers14194642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary A combination of radiotherapy and systemic antineoplastic agents is a common treatment strategy for lung cancer. However, Radiation recall pneumonitis (RRP) is a rare disease which has been mainly detected in the previously irradiated lung of patients with cancer after the application of triggering agents, including, but not limited to, antineoplastic agents. Physicians should be aware of this rare reaction, as the occurrence of RRP could impact the outcome of anti-cancer treatment. Given that current studies on RRP are primarily case reports and retrospectively reviewed data, the aim of our article was to review the current understanding and evidence on RRP and define the characteristics of RRP. Abstract Radiation recall pneumonitis (RRP) is a rare but severe condition which has been mainly detected in the previously irradiated lung of patients with cancer after administering inciting agents, most commonly antineoplastic regimens including chemotherapy, targeted therapy, or immunotherapy. More recently, coronavirus disease vaccines were found to induce RRP. In addition to typical radiation pneumonitis (RP) or drug-induced interstitial lung disease, the management of RRP requires withholding inciting agents and steroid therapy. Thus, the occurrence of RRP could significantly impact cancer treatment, given that inciting agents are withheld temporarily and even discontinued permanently. In the present review, we discuss the current understanding and evidence on RRP and provide additional insights into this rare but severe disease.
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2
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Wang M, Xu S, Zhu H. Radiation Recall Pneumonitis Induced by Sintilimab: A Case Report and Literature Review. Front Immunol 2022; 13:823767. [PMID: 35280981 PMCID: PMC8904715 DOI: 10.3389/fimmu.2022.823767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/31/2022] [Indexed: 01/03/2023] Open
Abstract
Radiation recall pneumonitis (RRP) is described as an unpredictable acute inflammatory reaction within the previously irradiated lung site during the administration of systematic therapy after radiotherapy. Here, we reported a case of a 54-year-old woman with non-small lung cancer (NSCLC), who had pneumonitis at 3 and 10 months after radiotherapy regarded as radiation pneumonitis (RP) and RRP induced by anti-PD-1 sintilimab, respectively. This unique patient with double pneumonitis (RP and RRP) has drawn attention to the identification of immune or radiation pneumonitis, its potential mechanism, and further treatment strategy after the emergence of RRP.
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Affiliation(s)
- Min Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shuhui Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute affiliated to Shandong University, Jinan, China
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3
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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.
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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
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4
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Strange CD, Shroff GS, Truong MT, Nguyen QN, Vlahos I, Erasmus JJ. Imaging of the post-radiation chest in lung cancer. Clin Radiol 2021; 77:19-30. [PMID: 34090709 DOI: 10.1016/j.crad.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/29/2021] [Indexed: 12/25/2022]
Abstract
Radiation therapy using conventional fractionated external-beam or high-precision dose techniques including three-dimensional conformal radiotherapy, stereotactic body radiation therapy, intensity-modulated radiation therapy, and proton therapy, is a key component in the treatment of patients with lung cancer. Knowledge of the radiation technique used, radiation treatment plan, expected temporal evolution of radiation-induced lung injury and patient-specific parameters, such as previous radiotherapy, concurrent chemoradiotherapy, and/or immunotherapy, is important in imaging interpretation. This review discusses factors that affect the development and severity of radiation-induced lung injury and its radiological manifestations with emphasis on the differences between conventional radiation and high-precision dose radiotherapy techniques.
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Affiliation(s)
- C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - Q-N Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - J J Erasmus
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA.
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5
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Miller AR, Manser R. The knowns & unknowns of pulmonary toxicity following immune checkpoint inhibitor therapies: a narrative review. Transl Lung Cancer Res 2021; 10:2752-2765. [PMID: 34295675 PMCID: PMC8264318 DOI: 10.21037/tlcr-20-806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
Since their discovery immune checkpoint inhibitors (ICI) have dramatically changed the treatment landscape for many cancers. In addition to their efficacy they are generally well tolerated, however, they have led to a new range of immune-related adverse events (irAEs) including pneumonitis. While not the most frequently reported immune-related adverse event in the clinical trial setting, recent real-world data suggests a significantly higher rate of pneumonitis leading to treatment suspension or cessation. It also appears to disproportionately contribute to immune-related mortality, particularly with anti-PD-1/PD-L1 treatment. While indicators have emerged regarding risk factors, incomplete prospective recording of patient characteristics hampers strong conclusions. Presenting symptoms are non-specific and the differential diagnosis is broad, made more complex by concomitant treatment with traditional chemotherapy or radiotherapy. Radiological findings are diverse and inconsistent terminology makes comparison and more complete characterization difficult. Further, little is known about the role of baseline testing or surveillance for early detection of pneumonitis, or the real-world role of bronchoscopy or biopsy in assessment. Scant literature exists to direct these complex decisions, so treatment guidelines have been published based on expert consensus. Here we provide a narrative review of what is known about ICI pneumonitis and propose key questions to enhance our understanding into the future.
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Affiliation(s)
- Alistair R Miller
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Victoria, Australia.,Department of Internal Medicine, Peter MacCallum Cancer Centre, Victoria, Australia.,Department of Medicine, Monash Health, Monash University, Victoria, Australia
| | - Renee Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Victoria, Australia.,Department of Internal Medicine, Peter MacCallum Cancer Centre, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
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6
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Patel NV, Samuels M, Elsayyad N. Ceftriaxone‐induced
radiation recall dermatitis. Head Neck 2020; 42:E8-E11. [DOI: 10.1002/hed.26154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/20/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nirav V. Patel
- Department of Radiation OncologyUniversity of Miami Sylvester Comprehensive Cancer Center Miami Florida USA
| | - Michael Samuels
- Department of Radiation OncologyUniversity of Miami Sylvester Comprehensive Cancer Center Miami Florida USA
| | - Nagy Elsayyad
- Department of Radiation OncologyUniversity of Miami Sylvester Comprehensive Cancer Center Miami Florida USA
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7
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Liu IC, Giap F, Mailhot-Vega RB, Bradley JA, Mendenhall NP, Okunieff P, Lu L, Jantz MA, Daily K, Spiguel L, Lockney NA. Concomitant Radiation Recall Dermatitis and Organizing Pneumonia following Breast Radiotherapy: A Case Report. Case Rep Oncol 2020; 13:875-882. [PMID: 32884534 PMCID: PMC7443621 DOI: 10.1159/000508493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Radiation recall dermatitis (RRD) is a rare complication that occurs after completion of radiation therapy (RT) and initiation of a precipitating agent, most commonly chemotherapeutic medications. Various theories attempt to explain the mechanism, including activation of the body's inflammatory pathways through nonimmune activation. Likewise, radiation-induced organizing pneumonia (RIOP) is an infrequent but potentially life-threatening complication of RT that, while not fully understood, is suspected to be partly an autoimmune reaction. Patient We present the case of a 71-year-old female with a history of type 2 diabetes mellitus, hypothyroidism, interstitial cystitis, and osteoarthritis who presented with clinical stage T1N0M0 ER+/PR–/HER2– invasive ductal carcinoma of the lower outer quadrant of the left breast, for which she underwent left segmental mastectomy and sentinel lymph node biopsy followed by completion axillary lymph node dissection. Her final pathologic stage was T1N1M0. Result The patient developed RRD and later RIOP following receipt of radiation and chemotherapy, which resolved with steroid administration. Conclusions The rarity of both RRD and RIOP occurring in a patient, as in our case, suggests a shared pathophysiology behind these two complications. As both reactions involve some degree of inflammation and respond to corticosteroids, it seems likely that the etiologies of RRD and RIOP lie within the inflammatory pathway. However, further investigation should evaluate the frequency, duration, and triggering of concomitant RRD and RIOP.
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Affiliation(s)
- I-Chia Liu
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Fantine Giap
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Raymond B Mailhot-Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nancy P Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Paul Okunieff
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Li Lu
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Michael A Jantz
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Karen Daily
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Lisa Spiguel
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Natalie A Lockney
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
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8
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Chen Y, Huang Z, Xing L, Meng X, Yu J. Radiation Recall Pneumonitis Induced by Anti-PD-1 Blockade: A Case Report and Review of the Literature. Front Oncol 2020; 10:561. [PMID: 32411597 PMCID: PMC7198764 DOI: 10.3389/fonc.2020.00561] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Radiation recall pneumonitis (RRP) is an unpredictable but relatively severe subclinical radiation damage which occurs in the previously irradiated fields of pulmonary tissue after administration of a systemic agent. Previous reports of RRP were mainly attributed to chemotherapy and molecular-target agents. RRP induced by immunotherapy has been rarely reported. Here we describe a case of a novel pattern of RRP induced by anti-PD-1 blockade Camrelizumab 2 years after radiotherapy, with some focus on further understanding of this phenomenon. Case Report: A 64-year-old man with non-small cell lung cancer (NSCLC) received two cycles of chemotherapy with cisplatin and pemetrexed first. Subsequently, he underwent concomitant chemoradiotherapy with cisplatin and pemetrexed to simultaneous integrated boost (SIB) radiotherapy. After 15 months, due to tumor progression and brain metastasis, he started with administration of anti-PD-1 blockade Camrelizumab (200 mg q2w) and stereotactic radiosurgery (SRS). The patient developed fever, dyspnea and cough after the eighth administration of Camrelizumab. Meanwhile, his chest CT revealed patchy consolidation and ground-glass opacities localized within the previously irradiated area. Subsequent treatment regimen was adjusted to 80 mg q12h prednisolone with discontinuation of Camrelizumab. Then the symptoms gradually eased and reexamination of CT showed significant improvement in RRP after 2 weeks. Conclusion: Our case report presents a novel pattern of RRP induced by anti-PD-1 blockade Camrelizumab 2 years after radiotherapy. This indicates that previous radiotherapy combined with subsequent anti-PD-1 blockade has a potential to cause overlapping damage to lung, suggesting that intensive attention might be needed for patients who are treated with anti-PD-1 blockade in conjunction with a prior history of thoracic radiation.
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Affiliation(s)
- Yu Chen
- Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhaoqin Huang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiangjiao Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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9
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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.
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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
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10
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Abstract
Lung injury associated with cancer therapeutics is often the limiting factor that trumps otherwise successful cancer therapy. Thoracic radiation as well as cancer pharmacotherapeutics, including conventional chemotherapy, molecular targeted agents, and cancer immunotherapies, have been associated with a unique spectrum of histopathologic injury patterns that may involve the lung parenchyma, pleura, airways, and/or pulmonary vasculature. Injury patterns may be idiosyncratic, unpredictable, and highly variable from one agent class to the next. Variability in lung injury patterns within a specific therapeutic class of drugs also occurs, adding to the conundrum. Drug-induced toxicities to the thoracic cavity are infrequent, and early recognition of clinical clues portends a good outcome in most cases. Failure to recognize early clinical signs, however, may result in irreversible and potentially lethal consequences. This chapter provides an overview of our current knowledge of thoracic complications associated with cancer pharmacotherapies. The review is not intended to be a treatise of all cancer agents that adversely affect the lungs, but rather a discussion of established risk factors and histopathologic patterns of lung injury associated with broad classes of cancer agents. Optimal management strategies, based on existing clinical experience, will also be discussed. Complications associated with thoracic radiation are also reviewed. It is hoped that these discussions will facilitate early recognition and management of treatment-related thoracic complications and, ultimately, better patient outcomes.
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Affiliation(s)
- Joseph L. Nates
- Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Kristen J. Price
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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11
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Zheng YM, Chow JM, Chang CL, Chao LH, Whang-Peng J, Lai GM. Hematuria induced by combination regorafenib and hyperthermia – a radiation recall effect. Int J Hyperthermia 2019; 36:1186-1189. [DOI: 10.1080/02656736.2019.1687941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Yu-Mei Zheng
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wan Fang Hospital, Taipei, Taiwan
| | - Jyh-Ming Chow
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wan Fang Hospital, Taipei, Taiwan
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Lun Chang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wan Fang Hospital, Taipei, Taiwan
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Liang-Hsiao Chao
- Consultant, Medical Physicist, Linden Bioscience Co, Taipei, Taiwan
| | - Jacqueline Whang-Peng
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wan Fang Hospital, Taipei, Taiwan
- College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
| | - Gi-Ming Lai
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Wan Fang Hospital, Taipei, Taiwan
- College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
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12
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Radiation recall pneumonitis in the setting of immunotherapy and radiation: a focused review. Future Sci OA 2019; 5:FSO378. [PMID: 31245041 PMCID: PMC6554692 DOI: 10.2144/fsoa-2018-0123] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/01/2019] [Indexed: 11/23/2022] Open
Abstract
Radiation recall pneumonitis (RRP) is an entity described as pneumonitis localized to a previously irradiated field after exposure to a systemic agent. It has previously been described in the literature in the context of chemotherapeutic agents as well as certain biologics. With immunotherapy taking a more prominent role in the treatment of several different malignancies and its own baseline risk of pneumonitis, it is important to explore the likelihood of RRP, specifically in those patients who have been previously treated with radiation therapy. The current literature regarding RRP with checkpoint inhibitors is reviewed in this article. Alongside this review, we report a case of RRP after pembrolizumab initiation in a patient in our practice.
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13
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Radiation recall pneumonitis in the setting of immunotherapy and radiation: a focused review. Future Sci OA 2019. [DOI: 10.4155/fsoa-2018-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Nakamura K, Okubo K, Takahashi T, Mitsumori K, Ishigaki T, Ohnishi H. Radiation recall pneumonitis induced by nivolumab in a patient with renal cell carcinoma. IJU Case Rep 2018; 2:30-33. [PMID: 32743367 PMCID: PMC7292071 DOI: 10.1002/iju5.12032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction A radiation recall reaction in previously irradiated lungs is known as radiation recall pneumonitis. We encountered a rare case of radiation recall pneumonitis induced by nivolumab 9 months after palliative radiotherapy to the ribs. Case presentation The patient was a 69-year-old woman with renal cell carcinoma. She had received various drugs and palliative irradiation, which was followed by nivolumab treatment, for renal cell carcinoma. Three days after the initial nivolumab administration, she presented with respiratory symptoms. On the basis of chest computed tomography findings, she was diagnosed with nivolumab-induced radiation recall pneumonitis and treated with prednisolone (1 mg/kg). The condition resolved rapidly, and chest computed tomography 4 months after nivolumab cessation revealed interval resolution of the lung consolidation and persistent tumor shrinkage. Conclusion Physicians should consider the risk of radiation recall pneumonitis during treatment with immune checkpoint inhibitors in patients who have received previous thoracic radiotherapy.
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Affiliation(s)
- Kenji Nakamura
- Department of Urology Osaka Red Cross Hospital Osaka Japan
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15
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Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N. Docetaxel-induced radiation recall dermatitis with atypical features: A case report. Medicine (Baltimore) 2018; 97:e12209. [PMID: 30200132 PMCID: PMC6133587 DOI: 10.1097/md.0000000000012209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Radiation recall dermatitis (RRD) associated with actinomycin D was first described by in 1959, followed by the reporting of several RRD-inducing drugs. In 1994, a study demonstrated docetaxel-induced RRD for the first time; however, despite some case studies reporting RRD, a little has been reported on it since then. Here we present a rare case of atypical docetaxel-induced RRD. CASE PRESENTATION The patient in his 60s was administered radiotherapy for high-risk prostate cancer. He continued receiving hormonal therapy for 2 years because of being in a high-risk group and became nadir. Six months since the completion of hormonal therapy, his prostate-specific antigen (PSA) level increased again. Based on the radiological examination, he was diagnosed with multiple lung, bone, and lymph node metastases. Accordingly, we started docetaxel (75 mg/m) every 5 weeks in consideration of myelosuppression for hormone-resistant multiple metastases. Although lung metastasis shrunk by one cycle docetaxel, radiotherapy for the thoracic and lumbar vertebrae was performed for back pain and lumbago. On day 21, at the end of radiotherapy, the same dose of docetaxel was administrated for the third time. On day 7, after third docetaxel administration, erythema appeared in a irradiated field of the thoracic and lumbar vertebra. Erythema primarily appeared on the anterior side of the body, and no skin reaction was noted on the posterior part of the thoracic irradiated area. Notably, no skin reaction was observed in the previously irradiated field for prostate cancer. CONCLUSIONS This case report draws attention to the development of atypical RRD after administration of docetaxel and advises careful follow-up even if RRD does not appear after the first docetaxel administration.
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16
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Kundak I, Oztop I, Soyturk M, Ozcan MA, Yilmaz U, Meydan N, Gorken IB, Kupelioglu A, Alakavuklar M. Paclitaxel-Carboplatin Induced Radiation Recall Colitis. TUMORI JOURNAL 2018; 90:256-8. [PMID: 15237594 DOI: 10.1177/030089160409000219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Some chemotherapeutic agents can “recall” the irradiated volumes by skin or pulmonary reactions in cancer patients who previously received radiation therapy. We report a recall colitis following the administration of paclitaxel-containing regimen in a patient who had been irradiated for a carcinoma of the uterine cervix. A 63-year-old woman underwent a Wertheim operation because of uterine cervix carcinoma. After 8 years of follow-up, a local recurrence was observed and she received curative external radiotherapy (45 Gy) to the pelvis. No significant adverse events were observed during the radiotherapy. Approximately one year later, she was hospitalized because of metastatic disease with multiple pulmonary nodules, and a chemotherapy regimen consisting of paclitaxel and carboplatin was administered. The day after the administration of chemotherapy the patient had diarrhea and rectal bleeding. Histological examination of the biopsy taken from rectal hyperemic lesions showed a radiation colitis. The symptoms reappeared after the administration of each course of chemotherapy and continued until the death of the patient despite the interruption of the chemotherapy. In conclusion, the probability of recall phenomena should be kept in mind in patients who received previously with pelvic radiotherapy and treated later with cytotoxic chemotherapy.
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Affiliation(s)
- Isil Kundak
- Department of Hematology-Oncology, Faculty of Medicine, University of Dokuz Eylul, Izmir, Turkey.
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17
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Ravishankar A, Park SS, Olivier KR, Corbin KS. Gemcitabine-Induced Radiation Recall Myositis: Case Report and Review of the Literature. Case Rep Oncol 2018; 11:168-178. [PMID: 29681817 PMCID: PMC5903158 DOI: 10.1159/000487478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 12/18/2022] Open
Abstract
Gemcitabine-induced radiation recall (GIRR) is a phenomenon wherein the administration of gemcitabine induces an inflammatory reaction within an area of prior radiation. We present the case of a 39-year-old female patient with metastatic breast cancer who experienced GIRR myositis 3 months following postoperative radiotherapy, with additional potential paraspinal myositis following ablative radiotherapy to the thoracic spine. A review of previously published cases of GIRR myositis was performed. The case and literature review describe the clinical course and presentation of GIRR, and highlight the importance of including radiation recall as part of a differential diagnosis when a patient undergoing chemotherapy experiences an inflammatory reaction at a prior site of radiation.
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Affiliation(s)
| | - Sean S Park
- Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth R Olivier
- Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kimberly S Corbin
- Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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18
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Murata H, Koyama K, Takezawa Y, Nishigaki Y. Baseline neutrophil-to-lymphocyte ratio predicts the prognosis of castration-resistant prostate cancer treated with abiraterone acetate. Mol Clin Oncol 2018; 8:592-594. [PMID: 29541468 DOI: 10.3892/mco.2018.1562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/28/2017] [Indexed: 02/03/2023] Open
Abstract
Abiraterone acetate (AA), a CYP17 inhibitor, now has a crucial role in the treatment of castration-resistant prostate cancer (CRPC), and previous studies have reported several prognostic clinical factors for AA treatment. The neutrophil-to-lymphocyte ratio (NLR) has also been investigated for a CRPC treatments in a few reports, however it has not been identified to be a prognostic factor for AA treatment in Japanese patients. The present study aimed to assess the association of the baseline NLR with the overall survival (OS) in CPRC patients treated by AA. The present study retrospectively reviewed a total of 90 consecutive patients with CRPC treated with AA from 2011 to 2016 at Yokohama City University Medical Center and National Cancer Center Hospital East. The primary endpoint of the study was the OS, which was defined as the survival from the start of AA administration. The secondary endpoint was the prostate-specific antigen (PSA) response. PSA response was defined as a reduction in antigen levels of >50%. Complete blood cell counts were performed, and the NLR was calculated using the neutrophil and lymphocyte counts obtained on the same day or a few days prior to the initiation of AA therapy. The NLR cut-off point was determined to be 3.76 for the OS, and divided into the high NLR group of 34 patients and the low NLR group of 56 patients. A PSA response was obtained in 8 patients (23.5%) in the high NLR group and in 24 (42.9%) in the low NLR group. The difference of PSA response between the two groups was significant (P=0.037). Kaplan-Meier curves demonstrated that a high NLR [NLR ≥3.76; median OS: 8.4 months; 95% confidence interval (CI): 6.325-10.475 months] was correlated with a risk of mortality compared with a low NLR (NLR <3.76; median OS not reached). A multivariate analysis demonstrated that the NLR was an independent predictor for the OS (hazard ratio: 2.682; 95% CI: 1.143-6.293; P=0.023). The findings suggest that the NLR may be a useful novel biomarker for predicting the prognosis of CRPC patients treated with AA.
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Affiliation(s)
- Hiroaki Murata
- Department Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Kenzou Koyama
- Department Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Yasunobu Takezawa
- Department Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Yasunori Nishigaki
- Department Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
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19
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Kim GE, Song HS, Ahn KJ, Kim YS. Radiation recall dermatitis triggered by sorafenib after radiation therapy for hepatocellular carcinoma. Radiat Oncol J 2017; 35:289-294. [PMID: 29037022 PMCID: PMC5647756 DOI: 10.3857/roj.2017.00339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022] Open
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.
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Affiliation(s)
- Gwi Eon Kim
- Department of Radiation Oncology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Hee-Sung Song
- Department of Nuclear Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Ki Jung Ahn
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University of Medicine, Busan, Korea
| | - Young Suk Kim
- Department of Radiation Oncology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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20
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Prévention médicale et traitement des complications pulmonaires secondaires à la radiothérapie. Cancer Radiother 2017; 21:411-423. [DOI: 10.1016/j.canrad.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/13/2017] [Accepted: 03/24/2017] [Indexed: 12/12/2022]
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21
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Mujtaba B, Narayanan S, Eugene Koay J, Elshikh M, E Madewell J, R Varadhachary G. Radiation Recall Masquerading as an Infectious Process. ACTA ACUST UNITED AC 2017. [DOI: 10.15406/ijrrt.2017.02.00047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Kainthola A, Haritwal T, Tiwari M, Gupta N, Parvez S, Tiwari M, Prakash H, Agrawala PK. Immunological Aspect of Radiation-Induced Pneumonitis, Current Treatment Strategies, and Future Prospects. Front Immunol 2017; 8:506. [PMID: 28512460 PMCID: PMC5411429 DOI: 10.3389/fimmu.2017.00506] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/12/2017] [Indexed: 12/21/2022] Open
Abstract
Delivery of high doses of radiation to thoracic region, particularly with non-small cell lung cancer patients, becomes difficult due to subsequent complications arising in the lungs of the patient. Radiation-induced pneumonitis is an early event evident in most radiation exposed patients observed within 2-4 months of treatment and leading to fibrosis later. Several cytokines and inflammatory molecules interplay in the vicinity of the tissue developing radiation injury leading to pneumonitis and fibrosis. While certain cytokines may be exploited as biomarkers, they also appear to be a potent target of intervention at transcriptional level. Initiation and progression of pneumonitis and fibrosis thus are dynamic processes arising after few months to year after irradiation of the lung tissue. Currently, available treatment strategies are challenged by the major dose limiting complications that curtails success of the treatment as well as well being of the patient's future life. Several approaches have been in practice while many other are still being explored to overcome such complications. The current review gives a brief account of the immunological aspects, existing management practices, and suggests possible futuristic approaches.
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Affiliation(s)
- Anup Kainthola
- Department of Radiation Genetics and Epigenetics, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Teena Haritwal
- Department of Radiation Genetics and Epigenetics, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Mrinialini Tiwari
- Department of Radiation Genetics and Epigenetics, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Noopur Gupta
- Department of Radiation Genetics and Epigenetics, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Suhel Parvez
- Department of Toxicology, School of Chemical and Life Sciences, Jamia Hamdard University, New Delhi, India
| | - Manisha Tiwari
- Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Hrideysh Prakash
- School of Life Sciences, Science complex, University of Hyderabad, Hyderabad, India
| | - Paban K. Agrawala
- Department of Radiation Genetics and Epigenetics, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
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23
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Ge J, Verma V, Hollander A, Langer C, Simone CB. Pemetrexed-induced radiation recall dermatitis in a patient with lung adenocarcinoma: case report and literature review. J Thorac Dis 2016; 8:E1589-E1593. [PMID: 28149588 DOI: 10.21037/jtd.2016.12.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Radiation recall dermatitis (RRD) is an inflammatory reaction in a previously irradiated field subsequent to the administration of pharmacologic or promoting agents. Herein, we describe a 47-year-old man with NSCLC who was treated with radiotherapy and pemetrexed-based chemotherapy three years prior to developing RRD upon resumption of pemetrexed-based chemotherapy. RRD with pemetrexed is rare and consists of five cases reported thus far. Although RRD is a rare phenomenon, it should be considered in any patient with dermatologic reactions that occur at the site of previous exposure to radiation therapy. When severe, RRD can pose a significant, and possibly life-threatening, impediment to the treatment and care of oncology patients. We discuss the time course, natural history, and management of this condition, as well as a connection to internal organ involvement, such as pneumonitis in thoracic oncology patients.
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Affiliation(s)
- Jin Ge
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Corey Langer
- Division of Medical Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
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24
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Kitajima T, Marumo S, Maeshima Y, Fukui M. Sequential adjuvant chemoradiotherapy-induced diffuse alveolar haemorrhage in a patient with breast cancer successfully treated with corticosteroid plus recombinant human soluble thrombomodulin. BMJ Case Rep 2016; 2016:bcr-2016-217183. [PMID: 27793868 DOI: 10.1136/bcr-2016-217183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The effective treatment for corticosteroid (CS)-refractory sequential chemoradiotherapy (CRT)-induced lung injury has not been established. We report a case of sequential CRT-induced diffuse alveolar haemorrhage (DAH) successfully treated with CS therapy plus recombinant human soluble thrombomodulin (rhTM). A 69-year-old woman was treated with sequential adjuvant CRT for early-stage breast cancer. After sequential CRT, she suffered from progressive dyspnoea. Chest CT scan showed consolidations in the irradiation field and diffuse ground-glass attenuations in the non-irradiation regions. We suspected sequential CRT-induced DAH because of increased haemosiderin-laden macrophages in bronchoalveolar lavage fluid. Her clinical conditions did not improve with high-dose CS therapy. Therefore, rhTM was added, and her disease and serum high-mobility group box-1 levels improved rapidly. Therefore, rhTM plus CS might be a safe and effective treatment for sequential CRT-induced lung injury, although further study is necessary to validate these findings.
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Affiliation(s)
- Takamasa Kitajima
- Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Respiratory Disease Center, Osaka, Japan
| | - Satoshi Marumo
- Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Respiratory Disease Center, Osaka, Japan
| | - Yurina Maeshima
- Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Breast Center, Osaka, Japan
| | - Motonari Fukui
- Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Respiratory Disease Center, Osaka, Japan
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25
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Tomiguchi M, Yamamoto Y, Hayashi M, Yamamoto-Ibusuki M, Murakami K, Iwase H. Docetaxel and cyclophosphamide chemotherapy induced radiation recall phenomenon in a postoperative breast cancer patient: a case report. Int Cancer Conf J 2016; 5:202-205. [PMID: 31149455 DOI: 10.1007/s13691-016-0258-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022] Open
Abstract
The radiation recall phenomenon (RRP) is an acute inflammatory reaction at a site previously treated with radiation, and is triggered by anti-cancer therapies such as chemotherapy or antibiotics. A 48-year-old Japanese woman with primary breast cancer underwent partial mastectomy and sentinel lymph node biopsy followed by postoperative radiotherapy. Subsequent to breast-conserving surgery, adjuvant chemotherapy, including docetaxel in combination with cyclophosphamide (TC), was administrated after 16 days of radiotherapy involving the right breast. The patient experienced the RRP with erythema and burning pain at the site of the irradiation fields at 6 days after the administration of TC. The skin symptoms resolved after treatment with topical corticosteroid therapy over a few days. After the second course of TC, the patient had only mild symptoms relative to the first course. She successfully completed four cycles of TC without dose reduction and treatment delay. We report this case involving the RRP induced by TC together with a review of the literature.
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Affiliation(s)
- Mai Tomiguchi
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Yutaka Yamamoto
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Mitsuhiro Hayashi
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Mutsuko Yamamoto-Ibusuki
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan.,2Department of Molecular-Targeting Therapy for Breast Cancer, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Keiichi Murakami
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
| | - Hirotaka Iwase
- 1Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556 Japan
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26
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Anker CJ, Grossmann KF, Atkins MB, Suneja G, Tarhini AA, Kirkwood JM. Avoiding Severe Toxicity From Combined BRAF Inhibitor and Radiation Treatment: Consensus Guidelines from the Eastern Cooperative Oncology Group (ECOG). Int J Radiat Oncol Biol Phys 2016; 95:632-46. [PMID: 27131079 PMCID: PMC5102246 DOI: 10.1016/j.ijrobp.2016.01.038] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/12/2016] [Accepted: 01/20/2016] [Indexed: 12/25/2022]
Abstract
BRAF kinase gene V600 point mutations drive approximately 40% to 50% of all melanomas, and BRAF inhibitors (BRAFi) have been found to significantly improve survival outcomes. Although radiation therapy (RT) provides effective symptom palliation, there is a lack of toxicity and efficacy data when RT is combined with BRAFi, including vemurafenib and dabrafenib. This literature review provides a detailed analysis of potential increased dermatologic, pulmonary, neurologic, hepatic, esophageal, and bowel toxicity from the combination of BRAFi and RT for melanoma patients described in 27 publications. Despite 7 publications noting potential intracranial neurotoxicity, the rates of radionecrosis and hemorrhage from whole brain RT (WBRT), stereotactic radiosurgery (SRS), or both do not appear increased with concurrent or sequential administration of BRAFis. Almost all grade 3 dermatitis reactions occurred when RT and BRAFi were administered concurrently. Painful, disfiguring nondermatitis cutaneous reactions have been described from concurrent or sequential RT and BRAFi administration, which improved with topical steroids and time. Visceral toxicity has been reported with RT and BRAFi, with deaths possibly related to bowel perforation and liver hemorrhage. Increased severity of radiation pneumonitis with BRAFi is rare, but more concerning was a potentially related fatal pulmonary hemorrhage. Conversely, encouraging reports have described patients with leptomeningeal spread and unresectable lymphadenopathy rendered disease free from combined RT and BRAFi. Based on our review, the authors recommend holding BRAFi and/or MEK inhibitors ≥3 days before and after fractionated RT and ≥1 day before and after SRS. No fatal reactions have been described with a dose <4 Gy per fraction, and time off systemic treatment should be minimized. Future prospective data will serve to refine these recommendations.
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Affiliation(s)
- Christopher J Anker
- Division of Radiation Oncology, University of Vermont Cancer Center, Burlington, Vermont.
| | - Kenneth F Grossmann
- Division of Medical Oncology, Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Michael B Atkins
- Department of Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, District of Columbia
| | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ahmad A Tarhini
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John M Kirkwood
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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27
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Meattini I, Desideri I, Di Cataldo V, Francolini G, De Luca Cardillo C, Scotti V, Loi M, Detti B, Mangoni M, Agresti B, Baldazzi V, Greto D, Casella D, Bernini M, Sanchez LJ, Orzalesi L, Nori J, Fambrini M, Bianchi S, Livi L. Safety of eribulin mesylate and concomitant radiotherapy for metastatic breast cancer: a single-center experience. Future Oncol 2016; 12:1117-24. [DOI: 10.2217/fon-2015-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study evaluates, for the first time, the safety of eribulin in metastatic breast cancer patients concomitantly treated with palliative radiotherapy (RT). Patients & materials: A total of 17 patients were pretreated for metastatic breast cancer. Patients received eribulin mesylate and bone RT. Results: The most frequent grade 3 hematologic adverse events were neutropenia (56%) and anemia (20%). Mean pain score decreased from 2 (baseline) to 0.7 (end of observation). Analgesic score remained stable (1.8 vs 1.6). Bone pain scores dropped within a few weeks and remained below baseline values throughout the analysis. The overall response rate was 29%, and the clinical benefit rate was 59%. Conclusion: Eribulin is characterized by a manageable safety profile also when combined with palliative RT.
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Affiliation(s)
- Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulio Francolini
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Carla De Luca Cardillo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Monica Mangoni
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Benedetta Agresti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Valentina Baldazzi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Donato Casella
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luis Jose Sanchez
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Senology Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Massimiliano Fambrini
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | | | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
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28
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Abstract
The basis of radiation recall reactions (RRR) is a subclinical radiation damage that is uncovered later by treatment with anticancer agents. Several drugs have been associated with RRR, in particular taxanes and anthracyclines. Recently, a few cases were reported concerning radiation recall dermatitis caused by vemurafenib. Up to now, there have been no reports of RRR in the lung induced by vemurafenib. We describe the occurrence of RRR in three melanoma patients who had undergone radiotherapy for metastases followed by systemic treatment with the BRAF inhibitor vemurafenib. Two patients developed radiation recall pneumonitis (RRP) and one patient developed radiation recall dermatitis (RRD) 5-7 weeks after the radiation treatment was finished and 2-4 weeks after vemurafenib was started. The early application of systemic (RRP) and topical corticosteroids (RRD) enabled us to continue the treatment with vemurafenib without dose reduction. Caution is needed when vemurafenib is planned for patients who have undergone previous radiotherapy, and RRR of the skin and the lung have to be taken into account.
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29
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Lee HE, Jeong NJ, Lee Y, Seo YJ, Kim CD, Lee JH, Im M. Radiation recall dermatitis and pneumonitis induced by trastuzumab (Herceptin®). Int J Dermatol 2014; 53:e159-60. [PMID: 24716200 DOI: 10.1111/j.1365-4632.2012.05788.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Waters MJ, Sukumaran S, Karapetis CS. Pemetrexed-Induced Interstitial Pneumonitis: A Case Study and Literature Review. World J Oncol 2014; 5:232-236. [PMID: 29147410 PMCID: PMC5649774 DOI: 10.14740/wjon845w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 12/14/2022] Open
Abstract
Pemetrexed is a new-generation antifolate drug, now widely used in patients with non-small cell lung cancer (NSCLC). We report a case of pemetrexed-induced interstitial pneumonitis, and review the literature of eight previously reported cases. As pemetrexed is now a widely used chemotherapeutic agent, it is important to be aware of rare adverse events related to its administration.
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Affiliation(s)
- Michael J Waters
- Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Shawgi Sukumaran
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, South Australia 5042, Australia
| | - Chris S Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, South Australia 5042, Australia
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31
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Omarini C, Thanopoulou E, Johnston SRD. Pneumonitis and pulmonary fibrosis associated with breast cancer treatments. Breast Cancer Res Treat 2014; 146:245-58. [PMID: 24929676 DOI: 10.1007/s10549-014-3016-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 05/28/2014] [Indexed: 01/07/2023]
Abstract
To review the available published data regarding the incidence, mechanisms of pathogenesis, clinical presentations and management of pneumonitis caused by anti-cancer treatments (radiotherapy (RT) and systemic agents) that are included in the guidelines of the treatment of breast cancer (BC) and address the issues on the current grading classification of pneumonitis. A literature search was performed between July and October 2013 using PubMed for papers published from January 1989 to October 2013. Any clinical trial, case report, case series, meta-analysis or systematic review that reported on pulmonary toxicity of any BC therapeutic modality was included (only papers published in English). Most of anticancer treatments currently used in the management of BC may induce some degree of pneumonitis that is estimated to have an incidence of 1-3 %. There is an obvious distinction between chemotherapy- and targeted treatment-related lung toxicity. Moreover, the current classification of pneumonitis needs to be modified as there is a clear diversity in grade 2. As pneumonitis is relatively common and reported as side effect of new anticancer agents, physicians need to be aware of the clinical and radiological manifestations of drug- and RT-induced toxicities in patients with BC. A key recommendation is the subdivision of grade 2 cases to two subgroups. We provide an algorithm, along with real life cases as managed in the breast Unit of Royal Marsden Hospital, with the aim to guide physicians in managing all possible eventualities that may come across in clinical practise.
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Affiliation(s)
- Claudia Omarini
- Department of Medicine, Royal Marsden NHS Foundation Trust, Fulham Road, Chelsea, London, SW3 6JJ, UK,
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32
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Castillo R, Pham N, Ansari S, Meshkov D, Castillo S, Li M, Olanrewaju A, Hobbs B, Castillo E, Guerrero T. Pre-radiotherapy FDG PET predicts radiation pneumonitis in lung cancer. Radiat Oncol 2014; 9:74. [PMID: 24625207 PMCID: PMC3995607 DOI: 10.1186/1748-717x-9-74] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 03/02/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A retrospective analysis is performed to determine if pre-treatment [18 F]-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) image derived parameters can predict radiation pneumonitis (RP) clinical symptoms in lung cancer patients. METHODS AND MATERIALS We retrospectively studied 100 non-small cell lung cancer (NSCLC) patients who underwent FDG PET/CT imaging before initiation of radiotherapy (RT). Pneumonitis symptoms were evaluated using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) from the consensus of 5 clinicians. Using the cumulative distribution of pre-treatment standard uptake values (SUV) within the lungs, the 80th to 95th percentile SUV values (SUV(80) to SUV(95) were determined. The effect of pre-RT FDG uptake, dose, patient and treatment characteristics on pulmonary toxicity was studied using multiple logistic regression. RESULTS The study subjects were treated with 3D conformal RT (n=23), intensity modulated RT (n=64), and proton therapy (n=13). Multiple logistic regression analysis demonstrated that elevated pre-RT lung FDG uptake on staging FDG PET was related to development of RP symptoms after RT. A patient of average age and V(30) with SUV(95)=1.5 was an estimated 6.9 times more likely to develop grade ≥ 2 radiation pneumonitis when compared to a patient with SUV(95)=0.5 of the same age and identical V(30). Receiver operating characteristic curve analysis showed the area under the curve was 0.78 (95% CI=0.69 - 0.87). The CT imaging and dosimetry parameters were found to be poor predictors of RP symptoms. CONCLUSIONS The pretreatment pulmonary FDG uptake, as quantified by the SUV(95), predicted symptoms of RP in this study. Elevation in this pre-treatment biomarker identifies a patient group at high risk for post-treatment symptomatic RP.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Thomas Guerrero
- The University of Texas Health Science Center, Houston, TX, USA.
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Management of normal tissue toxicity associated with chemoradiation (primary skin, esophagus, and lung). Cancer J 2013; 19:231-7. [PMID: 23708070 DOI: 10.1097/ppo.0b013e31829453fb] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Nearly one quarter of patients with lung cancer present with locally advanced disease where concurrent chemoradiotherapy is the current standard of care for patients with good performance status. Cisplatin-based concurrent chemoradiotherapy consistently showed an improvement in survival compared with sequential chemoradiotherapy, at the expense of an increase in the toxicity profile. Over the past decades, several encouraging biomarkers such as transforming growth factor-beta and radioprotective agents such as amifostine were studied but without reaching approval for patient care. We reviewed the prevalence and risk factors for different adverse effects associated with the combined chemoradiotherapy modality, especially dermatitis, mucositis, esophagitis, and pneumonitis. These adverse effects can further be divided into acute, subacute, and chronic. Dermatitis is usually rare and responds well to topical steroids and usual skin care. Acute esophagitis occurs in 30% of patients and is treated with proton pump inhibitors, promotility agents, local anesthetic, and dietary changes. Radiation pneumonitis is a subacute complication seen in 15% of patients and is usually managed with steroids. Chronic adverse effects such as radiation fibrosis and esophageal stricture occur approximately 6 months after completion of radiation therapy and are usually permanent. In this review, complications of chemoradiotherapy for patients with locally advanced lung cancer are delineated, and approaches to their management are described. Given that treatment interruption is associated with a worse outcome, patients are aggressively treated with a curative intent. Therefore, planning for treatment adverse effects improves patient tolerance, compliance, and outcome.
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Acevedo F, Arriagada P, Ibañez C, Ortega C, Muñoz P, Borghero Y, Bustos M, Sanchez C. Radiation recall dermatitis: report of two cases. Int Cancer Conf J 2013. [DOI: 10.1007/s13691-013-0099-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Takiar V, Strom EA, Baumann DP, Meric-Bernstam F, Alvarez RH, Gonzalez-Angulo AM. Locoregional interaction of ixabepilone (ixempra) after breast cancer radiation. Oncologist 2013; 18:265-70. [PMID: 23404814 DOI: 10.1634/theoncologist.2012-0348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Radiation recall is an acute inflammatory reaction within a previously irradiated field triggered by chemotherapy administration. We observed a series of patients with unexpectedly severe reactions that included radiation recall and delayed healing when patients received the microtubule stabilizer ixabepilone (Ixempra; Bristol-Myers Squibb, Princeton, NJ) after radiation. We therefore decided to evaluate our experience in patients receiving ixabepilone following radiotherapy. METHODS We performed a retrospective chart review of all patients treated with curative intent in the Department of Radiation Oncology at the MD Anderson Cancer Center from 2008-2011 who received any ixabepilone after completion of external-beam radiation therapy. These patients received adjuvant ixabepilone on one of two protocols, either for locally advanced breast cancer or for metastatic breast cancer. In total, 19 patients were identified and their charts were subsequently reviewed for evidence of ixabepilone-related toxicity. RESULTS Of the 19 patients identified who received ixabepilone following radiation therapy, three (15.8%) had unexpectedly serious reactions in the months following radiation therapy. Complications included delayed wound closure and drain placement into the seroma, intense erythema, and delayed wound closure and grade 4 chest wall necrosis requiring latissimus flap and skin grafting. The average number of days between the end of radiation therapy and documentation of reaction was 99. CONCLUSIONS Ixabepilone chemotherapy may induce radiation recall and delayed wound healing when used shortly after the completion of external-beam radiotherapy. Significant clinical interactions have not been previously reported and merit further evaluation.
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Affiliation(s)
- Vinita Takiar
- Department of Radiation Oncology, The University of TexasMDAnderson Cancer Center, Houston, Texas 77030, USA
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New-onset acute interstitial lung disease after treatment with erlotinib in a patient with metastatic squamous cell carcinoma of the lung. Am J Ther 2012; 18:e19-21. [PMID: 20019587 DOI: 10.1097/mjt.0b013e3181c2df83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Erlotinib is a Human Epidermal Growth Factor Receptor Type 1/tyrosine kinase (EGFR) inhibitor, which is used for non-small-cell lung cancer treatment. Erlotinib usually has a favorable safety profile however; adverse events such as interstitial lung disease (ILD) have been reported in pivotal studies. ILD usually occurs weeks to months after initiating therapy with Erlotinib. We report a case of Erlotinib induced ILD presenting within 5 days of initiating treatment with Erlotinib.
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Arakawa H, Johkoh T, Sakai F, Kusumoto M, Hataji O, Taguchi O. Exacerbation of radiation fibrosis with erlotinib: another pattern of radiation recall phenomenon. Jpn J Radiol 2011; 29:587-9. [DOI: 10.1007/s11604-011-0590-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/21/2011] [Indexed: 11/29/2022]
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Wo JY, Ryan DP, Kulke MH, Hong TS. Radiation recall associated with insulin growth factor 1R antibody. Pract Radiat Oncol 2011; 1:208-11. [PMID: 24673952 DOI: 10.1016/j.prro.2010.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/14/2010] [Accepted: 12/18/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - David P Ryan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew H Kulke
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Ding X, Ji W, Li J, Zhang X, Wang L. Radiation recall pneumonitis induced by chemotherapy after thoracic radiotherapy for lung cancer. Radiat Oncol 2011; 6:24. [PMID: 21375774 PMCID: PMC3063220 DOI: 10.1186/1748-717x-6-24] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/06/2011] [Indexed: 11/24/2022] Open
Abstract
Background Radiation recall pneumonitis (RRP) describes a rare reaction in previously irradiated area of pulmonary tissue after application of triggering agents. RRP remains loosely characterized and poorly understood since it has so far only been depicted in 8 cases in the literature. The objective of the study is to disclose the general characteristics of RRP induced by chemotherapy after thoracic irradiation for lung cancer, and to draw attention to the potential toxicity even after a long time interval from the previous irradiation. Methods Medical records were reviewed. RRP induced by chemotherapy was diagnosed by the history of chemotherapy after radiotherapy, clinical presentation and radiographic abnormalities including ground-glass opacity, attenuation, or consolidation changes within the radiation field, plus that radiographic examination of the thorax before showed no radiation pneumonitis. RRP was graded according to Common Terminology Criteria for Adverse Events version 3.0. The characteristics of the 12 RRP cases were analyzed. Results Twelve patients were diagnosed of RRP, of who 8 received taxanes. The median time interval between end of radiotherapy and RRP, between end of radiotherapy and beginning of chemotherapy, and between beginning of chemotherapy and RRP was 95 days, 42 days and 47 days, respectively. Marked symptomatic and radiographic improvement was observed in the 12 patients after withdrawal of chemotherapy and application of systemic corticosteroids. Seven patients were rechallenged with chemotherapy, of whom four with the same kind of agents, and showed no recurrence with steroid cover. Conclusions Doctors should pay attention to RRP even after a long time from the previous radiotherapy or after several cycles of consolidation chemotherapy. Taxanes are likely to be associated with radiation recall more frequently. Withdrawal of causative agent and application of steroids are the treatment of choice. Patients may be rechallenged safely with steroid cover and careful observation, which needs to be validated.
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Affiliation(s)
- Xiao Ding
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
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Abstract
There is still much that needs to be understood about radiation recall, and it is not currently possible to predict which patients will be affected and to which drugs they will react. Furthermore, there are no clearly defined 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 full-dose chemotherapy. 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.
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Rapid-Onset Acute Respiratory Distress Syndrome (ARDS) in a Patient Undergoing Metastatic Liver Resection: A Case Report and Review of the Literature. Anesthesiol Res Pract 2010; 2010. [PMID: 20814556 PMCID: PMC2931399 DOI: 10.1155/2010/586425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 05/10/2010] [Accepted: 07/03/2010] [Indexed: 01/11/2023] Open
Abstract
Metastatic liver resection following cytoreductive chemotherapy is an accepted treatment for oligometastatic tumor diseases. Although pulmonary complications are frequently reported in patients undergoing liver surgery including liver transplantation, life-threatening acute respiratory failures in the absence of aspiration, embolism, transfusion-related acute lung injury (TRALI), pulmonary infection, or an obvious source of systemic sepsis are rare. We performed an extensive clinical review of a patient undergoing metastatic liver resection who had a clinical course compatible to an acute respiratory distress syndrome (ARDS) without an obvious cause except for the surgical procedure and multiple preoperative chemotherapies. We hypothesize that either the surgical procedure mediated by cytokines and tumor necrosis factor or possible toxic effects of oxygen applied during general anesthesia were associated with life-threatening respiratory failure in the patient. Discrete and subclinical inflammated alveoli (probably due to multiple preoperative chemotherapies with substances at potential risk for interstitial pneumonitis as well as chest radiation) might therefore be considered as risk factors.
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Abstract
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.
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Affiliation(s)
- O Vujovic
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario.
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Ferrarotto R, Schetino G, Freitas D, Capelozzi V, Hoff PM. Paclitaxel induced chronic fibrosing interstitial pneumonitis: a case report and review of the literature. Oncol Rev 2010. [DOI: 10.1007/s12156-010-0043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Hird AE, Wilson J, Symons S, Sinclair E, Davis M, Chow E. Radiation recall dermatitis: case report and review of the literature. ACTA ACUST UNITED AC 2010; 15:53-62. [PMID: 18317586 PMCID: PMC2259426 DOI: 10.3747/co.2008.201] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
"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.
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Affiliation(s)
- A E Hird
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario
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Spirig C, Omlin A, D'Addario G, Loske KD, Esenwein P, Geismar JH, Ruhstaller T. Radiation recall dermatitis with soft tissue necrosis following pemetrexed therapy: a case report. J Med Case Rep 2009; 3:93. [PMID: 19946510 PMCID: PMC2783093 DOI: 10.1186/1752-1947-3-93] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 11/02/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Radiation recall dermatitis is a well known but still poorly understood inflammatory reaction. It can develop in previously irradiated areas and has been shown to be triggered by a variety of different drugs, including cytostatic agents. Pemetrexed may cause radiation recall dermatitis in pre-irradiated patients. CASE PRESENTATION We present the case of a 49-year-old Caucasian woman with non-small cell lung cancer who was initially treated with carboplatin and paclitaxel concomitant with radiotherapy after suffering a painful plexus brachialis infiltration. Due to disease progression, a second-line treatment with pemetrexed was started. A severe soft tissue necrosis developed despite steroid treatment and plastic surgery. CONCLUSION To the best of our knowledge, we present the first case of a patient with severe soft tissue necrosis in a pre-irradiated area after pemetrexed therapy. We believe that physicians treating patients with pemetrexed should be aware of the severe, possibly life-threatening effects that may be induced by pemetrexed after previous radiation therapy.
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Affiliation(s)
- Christian Spirig
- Department of Oncology-Hematology, Cantonal Hospital, St.Gallen, Switzerland
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McCurdy M, McAleer MF, Wei W, Ezhil M, Johnson V, Khan M, Baker J, Luo D, Ajani J, Guerrero T. Induction and concurrent taxanes enhance both the pulmonary metabolic radiation response and the radiation pneumonitis response in patients with esophagus cancer. Int J Radiat Oncol Biol Phys 2009; 76:816-23. [PMID: 19525073 DOI: 10.1016/j.ijrobp.2009.02.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 02/25/2009] [Accepted: 02/27/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE The primary aim of this study was to assess pulmonary radiation toxicity quantitatively in patients who received thoracic radiotherapy combined with induction and/or concurrent chemotherapy with or without taxanes for esophageal cancer. METHODS AND MATERIALS The study subjects were 139 patients treated at the University of Texas M.D. Anderson Cancer Center for esophageal cancer and who had undergone [(18)F]-fluorodeoxyglucose positron emission tomography/computed tomography between November 1, 2003 and December 15, 2007 for disease restaging after chemoradiotherapy. The patients were grouped into those who had not received taxanes (Group 1), those who had received induction or concurrent taxanes (Group 2), and those who had received both induction and concurrent taxanes (Group 3). Clinical pulmonary toxicity was scored using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3. Linear regression was applied to the fluorodeoxyglucose uptake vs. radiation dose to determine the pulmonary metabolic radiation response (PMRR) for each case. The clinical toxicity scores and PMRR among the groups were evaluated for significance differences. RESULTS The crude rate of pneumonitis symptoms was 46%, 62%, and 74% for Group 1, 2, and 3, respectively. The analysis of variance test of log(PMRR) by treatment was significant (p = .0046). Group 3 had a 61% greater PMRR compared with Group 1 (p = .002). Group 2 had a 38% greater PMRR compared with Group 1 (p = .015). Finally, Group 3 had a 17% greater PMRR compared with Group 2 (p = .31). A PMRR enhancement ratio of 1.60 (95% confidence interval, 1.19-2.14) was observed for Group 3 vs. Group 1. CONCLUSION Patients given induction and concurrent taxane chemotherapy had a significantly greater PMRR and clinical pneumonitis symptoms compared with the patients whose chemotherapy regimen did not include taxanes.
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Affiliation(s)
- Matthew McCurdy
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Jacob SE, Barland C, ElSaie ML. Patch-test-induced "flare-up" reactions to neomycin at prior biopsy sites. Dermatitis 2008; 19:E46-E48. [PMID: 19134429 DOI: 10.2310/6620.2008.08023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
"Recall dermatitis" classically refers to the uncommon phenomenon of chemotherapy-induced reactivation of skin damage originally induced by radiotherapy months or years earlier. We compare this condition to ectopic flare-up reactions presenting as dermatitis at existing or previous sites by an inducing agent. Enhanced sensitization of an existent allergen by patch testing is rarely described. We describe a case of a 61-year-old man's developing localized allergic contact dermatitis at previous neomycin-treated sites following the diagnosis of neomycin sensitivity on patch testing, which we attribute to a "flare-up" phenomenon.
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Affiliation(s)
- Sharon E Jacob
- Department of Dermatology and Cutaneous Surgery, University of California-San Diego, San Diego, CA, USA
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Vahid B, Marik PE. Pulmonary complications of novel antineoplastic agents for solid tumors. Chest 2008; 133:528-38. [PMID: 18252919 DOI: 10.1378/chest.07-0851] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Antineoplastic agent-induced pulmonary toxicity is an important cause of respiratory failure. Although the incidence of antineoplastic agent-induced pulmonary toxicity seems to be low, more cases can be expected, with increasing numbers of patients receiving the new generations of antineoplastic agents. Antineoplastic agents have previously been associated with bronchospasm, hypersensitivity reactions, venous thromboembolism, and pulmonary hemorrhage. Physicians should be aware of the clinical and radiographic presentations of the pulmonary toxicities associated with the newer antineoplastic agents. The approach to diagnosis, risk factors, and possible mechanisms of antineoplastic agent-induced pulmonary toxicity are discussed in this article.
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Affiliation(s)
- Bobbak Vahid
- Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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