Ferdause Jannatul, Islam Md Ariful, Ahmed Nusrat, Kadir A K M Shafiul, Haque Md Ariful
Department of Radiation Oncology, Ahsania Mission Cancer and General Hospital, Dhaka, Bangladesh.
Department of Histopathology, Ahsania Mission Cancer and General Hospital, Dhaka, Bangladesh.
Int J Surg Case Rep. 2024 Jul;120:109864. doi: 10.1016/j.ijscr.2024.109864. Epub 2024 Jun 5.
Radiation recall dermatitis (RRD) is a localized drug-induced inflammatory skin reaction occurring exclusively in a previously irradiated site months to years after discontinuation of ionizing radiation. The symptoms of RRD can range from mild redness to extensive dermatitis. Antineoplastic drugs such as doxorubicin, docetaxel, paclitaxel, and gemcitabine are most commonly associated with radiation recall reactions. These reactions can also occur with antibiotics and anti-tubercular drugs.
A 38-years-old woman with hormone receptor-negative, HER2-positive inflammatory breast cancer (right), clinical stage cT4dN1Mx, received neoadjuvant chemotherapy with AC > TH protocol at 3 weeks intervals (Anthracycline-Doxorubicin plus Cyclophosphamide X 4 cycles, then docetaxel plus Trastuzumab X 4 cycles) followed by modified radical mastectomy followed by adjuvant locoregional radiotherapy. She received the 5th cycle and 6th cycle trastuzumab monotherapy just before the start of surgery and radiotherapy, respectively. After 1 month of completion of radiotherapy, during her seventh cycle of Trastuzumab monotherapy, she developed mild edema with erythematous change over the previously irradiated area with fever. A skin biopsy was taken to exclude any recurrence; however, no evidence of malignancy was found.
We diagnosed it as a case of RRD. We managed her conservatively. Later, she was rechallenged with the same dose in subsequent cycles with systemic steroid coverage, which she tolerated very well, except for the reappearance of mild erythema following each cycle of maintenance dose of Trastuzumab.
Radiation recall dermatitis is an extremely rare phenomenon; hence, an acquaintance of clinicians with this rare entity is essential for timely diagnosis and appropriate management.
放射性回忆性皮炎(RRD)是一种局限性药物诱导的炎症性皮肤反应,仅发生在停止电离辐射数月至数年之后的先前照射部位。RRD的症状从轻度发红到广泛的皮炎不等。阿霉素、多西他赛、紫杉醇和吉西他滨等抗肿瘤药物最常与放射性回忆反应相关。这些反应也可发生于抗生素和抗结核药物。
一名38岁女性,患激素受体阴性、HER2阳性炎性乳腺癌(右侧),临床分期为cT4dN1Mx,接受了新辅助化疗,采用AC>TH方案,每3周进行一次(蒽环类药物-阿霉素加环磷酰胺共4个周期,然后多西他赛加曲妥珠单抗共4个周期),随后进行改良根治性乳房切除术,接着进行辅助性局部区域放疗。她分别在手术和放疗开始前接受了第5周期和第6周期的曲妥珠单抗单药治疗。放疗完成1个月后,在她第7周期曲妥珠单抗单药治疗期间,她在先前照射区域出现轻度水肿伴红斑改变,并伴有发热。进行了皮肤活检以排除任何复发情况;然而,未发现恶性肿瘤的证据。
我们将其诊断为RRD病例。我们对她进行了保守治疗。后来,在后续周期中,我们在给予全身类固醇覆盖的情况下,用相同剂量再次对她进行治疗,她耐受性良好,只是在每次维持剂量的曲妥珠单抗治疗后会再次出现轻度红斑。
放射性回忆性皮炎是一种极其罕见的现象;因此,临床医生了解这种罕见病症对于及时诊断和恰当管理至关重要。