Liu I-Chia, Giap Fantine, Mailhot-Vega Raymond B, Bradley Julie A, Mendenhall Nancy P, Okunieff Paul, Lu Li, Jantz Michael A, Daily Karen, Spiguel Lisa, Lockney Natalie A
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Pathology, University of Florida College of Medicine, Gainesville, Florida, USA.
Case Rep Oncol. 2020 Jul 29;13(2):875-882. doi: 10.1159/000508493. eCollection 2020 May-Aug.
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.
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.
The patient developed RRD and later RIOP following receipt of radiation and chemotherapy, which resolved with steroid administration.
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.
放射性回忆性皮炎（RRD）是一种罕见的并发症，发生于放射治疗（RT）结束并开始使用诱发剂之后，最常见的诱发剂是化疗药物。有多种理论试图解释其发病机制，包括通过非免疫激活激活机体的炎症途径。同样，放射性诱导的机化性肺炎（RIOP）是RT一种不常见但可能危及生命的并发症，虽然其发病机制尚未完全明确，但怀疑部分是一种自身免疫反应。
我们报告一例71岁女性病例，该患者有2型糖尿病、甲状腺功能减退、间质性膀胱炎和骨关节炎病史，因左乳外下象限临床分期为T1N0M0的雌激素受体阳性/孕激素受体阴性/人表皮生长因子受体2阴性浸润性导管癌就诊，为此她接受了左乳部分切除术和前哨淋巴结活检，随后完成腋窝淋巴结清扫。其最终病理分期为T1N1M0。
该患者在接受放疗和化疗后发生了RRD，随后又出现了RIOP，经使用类固醇治疗后症状缓解。
正如我们病例中所示，一名患者同时发生RRD和RIOP的情况很罕见，这表明这两种并发症背后存在共同的病理生理学机制。由于这两种反应都涉及一定程度的炎症且对皮质类固醇有反应，RRD和RIOP的病因似乎都与炎症途径有关。然而，进一步的研究应评估RRD和RIOP同时发生的频率、持续时间和触发因素。
