Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
CORRESPONDENCE
Year : 2014  |  Volume : 10  |  Issue : 4  |  Page : 1093-1097

Radiation recall phenomenon presenting as myositis triggered by carboplatin plus paclitaxel and related literature review


1 Department of Internal Medicine, Division of Hemato-Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
2 Department of Physical Medicine and Rehabilitation, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea

Date of Web Publication9-Jan-2015

Correspondence Address:
Jinmann Chon
Department of Physical Medicine and Rehabilitation, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, 23 Kyungheedae ro, Dongdaemun gu, Seoul - 30 701
Korea
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.146090

Rights and Permissions
 > Abstract 

While most case reports to date are radiation recall dermatitis, radiation recall myositis, which is a distinct form of radiation recall phenomenon caused by carboplatin plus paclitaxel, has not been reported. We treated a 57-year-old female patient who suffered from recurrent cervical cancer. When the patient developed a new left sacral metastasis, salvage radiotherapy (total dose 60 Gy) was administered. Four weeks later, chemotherapy using carboplatin plus paclitaxel was initiated. Four months after chemotherapy, the patient complained of severe pain in her left buttock. On magnetic resonance imaging (MRI), edematous changes and increased signal densities of left gluteus maximus and medius muscles were noted suggesting myositis. The border of the high signal intensity territory of the muscles was sharp and clearly corresponded with the recent irradiation field. We concluded that the patient had radiation recall myositis triggered by paclitaxel-carboplatin. Symptoms were controlled by analgesics, and there was no recurrence.

 > Abstract in Chinese 

卡铂加紫杉醇引发的放射性肌炎:相关文献回顾

摘要

虽然至今大多数的病例报告是放射性皮炎,放射性肌炎。由卡铂加紫杉醇引发的放射性召回反应尚未见报道。我们治疗了一个57岁的女性患者患,有复发性宫颈癌。当患者出现新的左骶骨转移,挽救性放疗(总剂量60 Gy)被实施。4周后,采用卡铂加紫杉醇化疗开始。化疗后4个月,病人主诉在她的左臀部疼痛。磁共振成像(MRI)上,水肿性变化和增强的左臀大肌和臀中肌信号密度提示肌炎。肌肉的高信号强度的边界清晰,显然与最近的放射野相关。我们认为患者系紫杉醇卡铂引发的放射性肌炎。症状通过镇痛药控制,无复发。

关键词:卡铂,紫杉醇,肌炎,放射性召回


Keywords: Carboplatin, myositis, paclitaxel, radiation recall


How to cite this article:
Maeng CH, Park JS, Lee SA, Kim DH, Yun DH, Yoo SD, Kim HS, Chon J. Radiation recall phenomenon presenting as myositis triggered by carboplatin plus paclitaxel and related literature review. J Can Res Ther 2014;10:1093-7

How to cite this URL:
Maeng CH, Park JS, Lee SA, Kim DH, Yun DH, Yoo SD, Kim HS, Chon J. Radiation recall phenomenon presenting as myositis triggered by carboplatin plus paclitaxel and related literature review. J Can Res Ther [serial online] 2014 [cited 2021 Jun 24];10:1093-7. Available from: https://www.cancerjournal.net/text.asp?2014/10/4/1093/146090


 > Introduction Top


Radiation recall is a rare phenomenon, which is defined as acute inflammation, triggered by subsequent chemotherapy that develops in a previously irradiated field. The first case of radiation recall was reported in 1959, and numerous cases have been diagnosed to date. [1] Radiation recall has been linked to a variety of chemotherapeutic agents, including 5-fluorouracil, capecitabine, anthracycline, gemcitabine, taxanes, oxaliplatin, vinorelbine, and cisplatin. [2],[3],[4],[5],[6],[7],[8] In addition, various antimicrobial agents have been considered as causative agents, [9],[10] and some investigators have reported radiation recall following molecular targeted therapy. [11],[12],[13] Radiation recall frequently presents as acute dermatitis [14] and differentiates from radiation-induced skin sensitization when chemotherapeutic agents are administrated more than 7 days after completion of radiotherapy. [2],[14]

While acute dermatitis is a common feature of radiation recall, some cases involve internal organs or tissues, particularly those treated with gemcitabine. [15],[16],[17],[18] However, radiation recall myositis is rarer than dermatitis, and this report describes a unique case of radiation recall myositis associated with chemotherapeutic agents other than gemcitabine.


 > Case report Top


A 57-year-old female was diagnosed with cervical cancer and underwent laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy in March 2006. The tumor was histologically confirmed as a squamous cell carcinoma. The surgery was performed with curative intent, and the surgical resection margin was negative; however, locoregional recurrent disease in pelvic cavity was found in 2010. Because there was no distant metastasis, the patient received cisplatin-based concurrent chemoradiotherapy. In April 2011, a newly developed metastasis of left side sacrum was found. A sacral laminectomy was performed to decrease the tumor burden because the patient still had no distant metastasis. Salvage radiotherapy was administered subsequently. The total irradiation dose was 60 Gy in 42 fractions. Four weeks after the completion of radiotherapy, salvage chemotherapy using carboplatin plus paclitaxel was initiated for six cycles from October 2011 to January 2012.

Approximately four months after chemotherapy was initiated, the patient complained of severe pain in her left buttock and lower extremity. Physical examination revealed local tenderness around the affected area, although there was no sensory deficit. Subsequently, we performed lumbosacral spine magnetic resonance imaging (MRI) to evaluate possible etiologies. We observed that the left gluteus maximus and gluteus medius muscles had diffusely increased signal densities [Figure 1]. Furthermore, edematous changes in the affected muscles were noted on the high short TI inversion recovery signal density. These findings were suggestive of myositis. Interestingly, the affected area clearly corresponded with the recent irradiation field. Other muscle disease or metastatic lesions could be excluded because the border of the high signal intensity territory was sharp and the intensity was diffuse in pattern. Because the myositis appeared 4 months after completion of radiotherapy, we concluded that the patient had radiation recall myositis triggered by paclitaxel-carboplatin. Symptoms were controlled by analgesics, and there was no recurrence.
Figure 1: An MRI image with high short TI inversion recovery signal density of the gluteus muscle with diffuse enhancement of the involved area on the lumbar spine (A, transverse and B, sagittal view). The area matched a prior irradiated field

Click here to view



 > Discussion Top


Radiation recall is a well-known phenomenon, although the detailed pathophysiology remains to be elucidated. There are many potential causative agents triggering radiation recall, and the phenomenon is drug-specific with a clinical presentation that varies among individuals. Predicting the development of radiation recall is not possible, even though a prior episode of radiation recall does not preclude patients from challenging the drug again. [2],[19] Most cases of radiation recall report the phenomena as acute inflammation involving cutaneous tissue, and the related drugs are often anticancer agents. [2] Acute dermatitis of radiation recall is probably caused by a hypersensitivity reaction with idiosyncrasy. [14] Histological findings characterized by epidermal dysplasia, necrotizing keratinocytes, increased mitotic figures, and local inflammatory infiltration are typical pathological changes, suggesting an important role for radiation. [20] Chemotherapeutic agents can potentiate the inflammatory process, resulting in dermatitis. [20] Although most cases of radiation recall are dermatitis, some investigators also report other rare forms, such as myositis.

We reviewed the available literature reporting radiation recall myositis by searching PubMed with the keywords "radiation recall" and "myositis," and the related articles were checked and reviewed [Table 1]. The time intervals between completion of radiotherapy and initiation of chemotherapy did not exceed 5 months, although the statistical relevance could not be determined. The reported symptoms were primarily pain of the involved muscles and edematous changes noted on computed tomography (CT) or MRI. Painful muscles were well controlled by corticosteroid and/or non-steroidal anti-inflammatory drugs (NSAIDs) or by discontinuation of the causative drug. There was no recurring phenomenon among the patients who received the culprit drug again after symptoms were relieved, with the exception of one case. [21] The most commonly reported causative drug was gemcitabine. Interestingly, there were no cases driven by paclitaxel or carboplatin, which were the triggering agents in our case. It is not clear which of these two drugs was directly responsible for the phenomenon. To the best of our knowledge, this is the first report of radiation recall myositis induced by paclitaxel and carboplatin. In the literature review, there was one report of a patient treated with gemcitabine plus carboplatin. [22] However, the authors concluded that gemcitabine, and not carboplatin, was the triggering drug, although there was no definite explanation. There have been several published cases of radiation recall dermatitis induced by paclitaxel, [23],[24],[25],[26] and another report of paclitaxel and carboplatin-caused radiation recall colitis. [27] In that case, colitis-related symptoms started the day after administration of chemotherapy. In our case, the time interval between the end of radiotherapy and the beginning of chemotherapy was approximately 1 month, whereas radiation recall myositis developed 4 months after chemotherapy, which was not a significantly different trend from previous reports. Even though we did not re-administer the chemotherapeutic agents, based on previous reports, it was possible to administer chemotherapy safely, but with caution, if the patient recovered from recall phenomenon and the response to chemotherapy remained. A limitation of this case report was a lack of pathological confirmation of the involved soft tissue. However, a biopsy was not possible because the patient complained of severe buttock pain, and we treated her symptoms promptly and successfully. A biopsy was not essential in our case because radiation recall is generally diagnosed with consideration of the relevant patient history, related symptoms, and typical images from a radiological study, such as CT or MRI. [28]
Table 1: Reported cases of radiation recall myositis induced by chemotherapeutic agents

Click here to view



 > Conclusions Top


Radiation recall induced by chemotherapy can comprise myositis, as well skin inflammation. It is triggered by various agents, including gemcitabine, which is one of the most commonly reported anticancer drugs associated with radiation recall myositis. However, as we report here, paclitaxel plus carboplatin can also cause radiation recall myositis. Physicians should be educated about this disease in order to manage this idiosyncratic phenomenon whenever patients receive chemotherapy followed by radiotherapy.[37]

 
 > References Top

1.
D′Angio GJ, Farber S, Maddock CL. Potentiation of x-ray effects by actinomycin D. Radiology 1959;73:175-7.  Back to cited text no. 1
    
2.
Burris HA 3 rd , Hurtig J. Radiation recall with anticancer agents. Oncologist 2010;15:1227-37.  Back to cited text no. 2
    
3.
Jeter MD, Janne PA, Brooks S, Burstein HJ, Wen P, Fuchs CS, et al. Gemcitabine-induced radiation recall. Int J Radiat Oncol Biol Phys 2002;53:394-400.  Back to cited text no. 3
    
4.
Gabel C, Eifel PJ, Tornos C, Burke TW. Radiation recall reaction to idarubicin resulting in vaginal necrosis. Gynecol Oncol 1995;57:266-9.  Back to cited text no. 4
    
5.
Bokemeyer C, Lampe C, Heneka M, Schabet M, Bamberg M, Kanz L. Paclitaxel-induced radiation recall dermatitis. Ann Oncol 1996;7:755-6.  Back to cited text no. 5
    
6.
Magne N, Benezery K, Otto J, Namer M, Lagrange JL. [Radiation recall dermatitis after docetaxel and external beam radiotherapy. Report of two cases and review of the literature]. Cancer Radiother 2002;6:281-4.  Back to cited text no. 6
    
7.
Chan RT, Au GK, Ho JW, Chu KW. Radiation recall with oxaliplatin: Report of a case and a review of the literature. Clin Oncol (R Coll Radiol) 2001;13:55-7.  Back to cited text no. 7
    
8.
Zhu ZF, Fan M, Fu XL. Radiation recall with vinorelbine and cisplatin. Onkologie 2010;33:107-9.  Back to cited text no. 8
    
9.
Kang SK. Images in clinical medicine. Radiation recall reaction after antimicrobial therapy. N Engl J Med 2006;354:622.  Back to cited text no. 9
    
10.
Wernicke AG, Swistel AJ, Parashar B, Myskowski PL. Levofloxacin-induced radiation recall dermatitis: A case report and a review of the literature. Clin Breast Cancer 2010;10:404-6.  Back to cited text no. 10
    
11.
Shrimali RK, McPhail NJ, Correa PD, Fraser J, Rizwanullah M. Trastuzumab-induced radiation recall dermatitis - first reported case. Clin Oncol (R Coll Radiol) 2009;21:634-5.  Back to cited text no. 11
    
12.
Dauendorffer JN, Dupuy A. Radiation recall dermatitis induced by erlotinib. J Am Acad Dermatol 2009;61:1086.  Back to cited text no. 12
    
13.
Moon D, Koo JS, Suh CO, Yoon CY, Bae J, Lee S. Radiation recall dermatitis induced by trastuzumab. Breast Cancer 2013.  Back to cited text no. 13
    
14.
Camidge R, Price A. Characterizing the phenomenon of radiation recall dermatitis. Radiother Oncol 2001;59:237-45.  Back to cited text no. 14
    
15.
Friedlander PA, Bansal R, Schwartz L, Wagman R, Posner J, Kemeny N. Gemcitabine-related radiation recall preferentially involves internal tissue and organs. Cancer 2004;100:1793-9.  Back to cited text no. 15
    
16.
Castellano D, Hitt R, Cortes-Funes H, Romero A, Rodriguez-Peralto JL. Side effects of chemotherapy. Case 2. Radiation recall reaction induced by gemcitabine. J Clin Oncol 2000;18:695-6.  Back to cited text no. 16
    
17.
Welsh JS, Torre TG, DeWeese TL, O′Reilly S. Radiation myositis. Ann Oncol 1999;10:1105-8.  Back to cited text no. 17
    
18.
Ganem G, Solal-Celigny P, Joffroy A, Tassy D, Delpon A, Dupuis O. Radiation myositis: The possible role of gemcitabine. Ann Oncol 2000;11:1615-6.  Back to cited text no. 18
    
19.
Lock M, Sinclair K, Welch S, Younus J, Salim M. Radiation recall dermatitis due to gemcitabine does not suggest the need to discontinue chemotherapy. Oncol Lett 2011;2:85-90.  Back to cited text no. 19
    
20.
Smith KJ, Germain M, Skelton H. Histopathologic features seen with radiation recall or enhancement eruptions. J Cutan Med Surg 2002;6:535-40.  Back to cited text no. 20
    
21.
Hattangadi J, Esty B, Winey B, Duigenan S, Huang M, Yock T. Radiation recall myositis in pediatric Ewing sarcoma. Pediatr Blood Cancer 2012;59:570-2.  Back to cited text no. 21
    
22.
Fogarty G, Ball D, Rischin D. Radiation recall reaction following gemcitabine. Lung Cancer 2001;33:299-302.  Back to cited text no. 22
    
23.
McCarty MJ, Peake MF, Lillis P, Vukelja SJ. Paclitaxel-induced radiation recall dermatitis. Med Pediatr Oncol 1996;27:185-6.  Back to cited text no. 23
    
24.
Phillips KA, Urch M, Bishop JF. Radiation-recall dermatitis in a patient treated with paclitaxel. J Clin Oncol 1995;13:305.  Back to cited text no. 24
    
25.
Schweitzer VG, Juillard GJ, Bajada CL, Parker RG. Radiation recall dermatitis and pneumonitis in a patient treated with paclitaxel. Cancer 1995;76:1069-72.  Back to cited text no. 25
    
26.
Shenkier T, Gelmon K. Paclitaxel and radiation-recall dermatitis. J Clin Oncol 1994;12:439.  Back to cited text no. 26
    
27.
Kundak I, Oztop I, Soyturk M, Ozcan MA, Yilmaz U, Meydan N, et al. Paclitaxel-carboplatin induced radiation recall colitis. Tumori 2004;90:256-8.  Back to cited text no. 27
    
28.
Caloglu M, Yurut-Caloglu V, Cosar-Alas R, Saynak M, Karagol H, Uzal C. An ambiguous phenomenon of radiation and drugs: Recall reactions. Onkologie 2007;30:209-14.  Back to cited text no. 28
    
29.
Graf SW, Limaye VS, Cleland LG. Gemcitabine-induced radiation recall myositis in a patient with dermatomyositis. Int J Rheum Dis 2013.  Back to cited text no. 29
    
30.
Eckardt MA, Bean A, Selch MT, Federman N. A child with gemcitabine-induced severe radiation recall myositis resulting in a compartment syndrome. J Pediatr Hematol Oncol 2013;35:156-61.  Back to cited text no. 30
    
31.
O′Regan KN, Nishino M, Armand P, Kelly PJ, Hwang DG, Di Salvo D. Sonographic features of pectoralis muscle necrosis secondary to gemcitabine-induced radiation recall: Case report and review of current literature. J Ultrasound Med 2010;29:1499-502.  Back to cited text no. 31
    
32.
Heirwegh G, Bruyeer E, Renard M, Uyttebroeck A, Demaerel P. Radiation-recall myositis presenting as low-back pain (2010: 4b). Eur Radiol 2010;20:1799-801.  Back to cited text no. 32
    
33.
Horan G, Smith SL, Podd TJ. Gemcitabine-induced radiation necrosis of the pectoralis major muscle. Clin Oncol (R Coll Radiol) 2006;18:85.  Back to cited text no. 33
    
34.
Fakih MG. Gemcitabine-induced rectus abdominus radiation recall. JOP 2006;7:306-10.  Back to cited text no. 34
    
35.
Squire S, Chan M, Feller E, Mega A, Gold R. An unusual case of gemcitabine-induced radiation recall. Am J Clin Oncol 2006;29:636.  Back to cited text no. 35
    
36.
Borroni G, Vassallo C, Brazzelli V, Martinoli S, Ardigo M, Alessandrino PE, et al. Radiation recall dermatitis, panniculitis, and myositis following cyclophosphamide therapy: Histopathologic findings of a patient affected by multiple myeloma. Am J Dermatopathol 2004;26:213-6.  Back to cited text no. 36
    
37.
Indinnimeo M, Cicchini C, Kanakaki S, Larcinese A, Mingazzini PL. Chemotherapy-induced radiation recall myositis. Oncol Rep 2003;10:1401-3.  Back to cited text no. 37
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Case report>Discussion>Conclusions>Article Figures>Article Tables
  In this article
>References

 Article Access Statistics
    Viewed3722    
    Printed96    
    Emailed1    
    PDF Downloaded164    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]