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.

/pdf/radiation-recall-with-anticancer-agents-3nbj5fpi78.pdf

Radiation Recall with Anticancer Agents

Radiation recall: a well recognized but neglected phenomenon.

Purpose: To study and report 6 patients with radiation recall in unique sites, secondary to gemcitabine chemotherapy Methods and Materials: The clinical presentations and outcomes of 6 patients with radiation recall secondary to gemcitabine chemotherapy were retrospectively analyzed over the course of a 1-year period Results: Radiation recall reactions were seen in the central nervous system, skin, gastrointestinal tract, and in the lymphatic and musculoskeletal systems The time between initiation of radiation and recall of the radiation phenomenon ranged from 3 weeks to 8 months from the time gemcitabine was initiated The usual dosage of gemcitabine in these cases was 1000 mg/m 2 given on a weekly basis No radiation therapy was given concomitantly with gemcitabine Treatment of the recall reaction consisted of discontinuing gemcitabine and initiating steroid therapy, supportive therapy, and/or nonsteroidal anti-inflammatory agents Minimal improvement was seen in 3 out of 6 patients, and resolution of the radiation recall was seen in 3 out of 6 patients A comprehensive review of the literature revealed that radiation recall with gemcitabine has been related to skin reactions only; no previous cases of radiation recall occurring in the central nervous system have been reported with any chemotherapy agent Conclusion: Radiation recall from gemcitabine chemotherapy is rare, but can potentially arise in any site that has been previously irradiated Treating physicians must be aware of this potential toxicity from gemcitabine and radiation and discontinue the gemcitabine if radiation recall is observed

Gemcitabine-induced radiation recall

Background. Radiation recall refers to a tissue reac- ion produced by a chemotherapeutic agent in a pre- riously irradiated field that would not occur in a nonir- tadiated field. A number of agents have been reported to :awe radiation recall. Recently, there have been case re- ,arts of recall dermatitis from paclitaxel treatment. Methods. A patient with metastatic lung cancer re- :eived palliative radiation to her mediastinum and ribs. Secause

Radiation recall dermatitis and pneumonitis in a patient treated with paclitaxel

Background. Radiation recall is a recurrence of acute toxicity within a previously quiescent radiation field that occurs with subsequent administration of chemotherapy.



Methods. A patient with acquired immune deficiency syndrome (AIDS)-related Kaposi sarcoma (KS) who had radiation recall is reported. The patient was participating in a randomized prospective trial of radiation treatment regimens for KS. Each lesion was randomized to one of three possible radiation fractionation schemes. All lesions were photographed and measured before treatment with radiation.



Results. Two skin sites developed erythema and dry desquamation 18 days after completion of radiation therapy to a dose of 40 Gy in 20 fractions. These reactions took place after the second dose of bleomycin administered intravenously on a weekly basis. The reactions were exacerbated by oral etoposide therapy, which was started 4 days after the recall phenomenon was noted. Other cutaneous sites treated with 8 Gy in a single fraction and 20 Gy in ten fractions during the same time period showed no sign of recall skin toxicity.



Conclusions. The authors believe this to be the first report of radiation recall toxicity after bleomycin therapy and of a radiation dose response related to this phenomenon. The potential for radiation recall toxicity should be considered in treatment decisions pertaining to patients with AIDS-associated KS.

Radiation recall skin toxicity with bleomycin in a patient with kaposi sarcoma related to acquired immune deficiency syndrome

A 22-year-old man developed four episodes of bowel obstruction after radiation therapy for a testicular tumor metastatic to retroperitoneal nodes. Each episode followed a course of chemotherapy with actinomycin-D or adriamycin. On one occasion bowel resection was required and revealed vascular changes compatible with radiation injury. The case appears to be an example of radiation recall injury involving the small bowel. The decision to use actinomycin-D or adriamycin must be weighed against the risk of tissue injury when a predisposition to radiation damage is present.

Stein Rs

Papers

Radiation-recall enteritis after actinomycin-D and adriamycin therapy.