Choi Seong Ji, Kim Hyo Jung, Kim Jae Seon, Bak Young-Tae, Kim Jun Suk
Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
BMC Cancer. 2016 Aug 2;16:588. doi: 10.1186/s12885-016-2616-3.
Radiation recall gastritis is rare but can be induced after concurrent chemoradiation for pancreatic cancer. We report a patient with pancreatic cancer who developed radiation-recall gastritis related to a combination of gemcitabine and erlotinib.
A 54-year-old female with unresectable pancreatic cancer received gemcitabine in combination with radiation therapy followed by chemotherapy with gemcitabine and erlotinib. After completing 2 cycles of chemotherapy, the patient had epigastric pain, nausea, and vomiting. Abdominal computed tomography (CT) scan revealed diffuse wall thickening of the stomach, and esophagogastroduodenoscopy (EGD) showed multiple gastric ulcers. The patient was treated with proton pump inhibitors (PPI) and was continued on maintenance chemotherapy. Two months later, the patient presented with the similar symptoms and persistent gastric ulcers were observed during subsequent EGD. Nevertheless, the patient's symptom had resolved with PPI therapy. Thus, the patient underwent maintenance chemotherapy with gemcitabine and erlotinib for additional 4 cycles. Eventually, follow-up abdominal CT Scan and EGD at 6 months demonstrated resolution of the gastric ulcers.
Physicians should be aware of the possibility of radiation recall gastritis associated with a combination of gemcitabine and erlotinib. Administration of PPIs may mitigate the adverse effects of gemcitabine and erlotinib in the presence of radiation recall gastritis; however further studies are warranted.
放射性胃炎较为罕见，但可在胰腺癌同步放化疗后诱发。我们报告了1例胰腺癌患者，其发生了与吉西他滨和厄洛替尼联合使用相关的放射性胃炎。
1例54岁不可切除胰腺癌女性患者接受了吉西他滨联合放疗，随后接受吉西他滨和厄洛替尼化疗。完成2个周期化疗后，患者出现上腹部疼痛、恶心和呕吐。腹部计算机断层扫描（CT）显示胃壁弥漫性增厚，食管胃十二指肠镜检查（EGD）显示多发胃溃疡。患者接受质子泵抑制剂（PPI）治疗，并继续维持化疗。2个月后，患者出现类似症状，后续EGD检查发现胃溃疡持续存在。然而，患者的症状经PPI治疗后缓解。因此，患者继续接受吉西他滨和厄洛替尼维持化疗4个周期。最终，6个月后的随访腹部CT扫描和EGD显示胃溃疡已消失。
医生应意识到吉西他滨和厄洛替尼联合使用可能导致放射性胃炎。在出现放射性胃炎时，使用PPI可能减轻吉西他滨和厄洛替尼的不良反应；然而，仍需进一步研究。
