Case study Strahlenther Onkol 2014 ∙ 190:491–493 DOI 10.1007/s00066-014-0609-1 Received: 9 October 2013 Accepted: 18 December 2013 Published online: 11 March 2014 © Springer-Verlag Berlin Heidelberg 2014
Viola Duncker-Rohr · Ulrich Freund · Felix Momm Radio-Onkologie, Ortenau-Klinikum Offenburg-Gengenbach, Lehrkrankenhaus der Albert-Ludwigs-Universität Freiburg i. Br., Offenburg, Germany
Radiation recall dermatitis after docetaxel chemotherapy Treatment by antioxidant ointment
Introduction
Case report
Radiation recall dermatitis (RRD) is an acute skin toxicity in a former irradiation field completely healed from radiation side effects. It is typically caused by anticancer or antibiotic agents given to the patient weeks, months, or even years after the end of radiotherapy [1, 9, 10, 12, 16, 19, 21]. Skin reactions occurring within 7 days of radiotherapy are thought to be induced by direct radiosensitization. Sufficient quantification of RRD can be obtained by clinical scoring with Common Toxicity Criteria (CTC) [6, 14]. In the literature, stopping the agent causing the dermatitis and starting treatment with local or systemic cortisone medication are recommended for patients with recall effects [21]. Replacing anticancer or antibiotic agents by equivalent alternatives may cause significant problems, as these alternatives might not exist. Cortisone may not be used in patients with infectious diseases or in cancer patients with compromised immune defense. Therefore, an alternative strategy in the treatment of RRD should be developed. The mechanisms of radiation recall occurrence are not completely known [1, 10, 21]. However, some authors propose local free radicals or oxidants as being responsible for recall dermatitis. Therefore, we decided to test an antioxidant ointment (Mapisal®) for the treatment of a patient with RRD caused by docetaxel. In Germany, Mapisal® is authorized for the treatment of chemotherapy-induced hand– foot syndrome, which may be caused by similar pathogenetic effects as RRD.
A 63-year-old Caucasian patient presented with prostate cancer and simultaneous bone metastases (stage cT2c cN0 M1 Gleason score 5 + 5 = 10). The patient’s prostate-specific antigen (PSA) level was 36.25 ng/ml. He received antihormonal and antiandrogen therapy for 6 months as well as monthly denosumab injections. Initially, this therapy worked well and the PSA level decreased. After 6 months, however, the PSA level increased again to 50.83 ng/ml, although the testosterone level was low (0.09 µg/l). The patient reported significant pelvic and spinal pain and progression of the bone metastases was diagnosed. Therefore, we decided for a docetaxel chemotherapy and irradiation of the symptomatic bone metastases. Three cycles of docetaxel at 75 mg/ m2 on day 1, with a repeat on day 22, were given. Parallel to the third cycle of chemotherapy, radiotherapy (five fractions of2 Gy per week, total dose 40 Gy, CTbased 3D planning) to the pelvis and the lumbar spine was given (180° port shown in . Fig. 1a). Due to the radiotherapy, the third chemotherapy cycle was given at a reduced dose (80 %). In spite of parallel chemotherapy, the patient tolerated the radiotherapy well and without any visible skin reaction. After this treatment the PSA level decreased to 29.2 ng/ml and the patient received another three cycles (cycles 4–6) of docetaxel. Following cycle 5, 3 months after completion of radiotherapy, he presented with massive dermatitis of CTC grade 3–4 [6] in the dorsal irradiation field (. Fig. 1b).
He reported great pain, visual analogue scale (VAS) score of 8/10. Self-medication with diclophenac did not result in sufficient, long-lasting pain relief. Considering the erythema was exactly within the 180° radiation field, we diagnosed a radiation recall dermatitis. The patient received the antioxidant ointment Mapisal® for topical use three times per day without any other comedication. Five days later, there was significantly reduced pain (VAS score 2/10) and improvement of acute skin reactions (. Fig. 1c). He reported significant pain relief starting on the first day of ointment use. We decided to continue with chemotherapy. Three weeks later the dermatitis had completely resolved except for a slight hyperpigmentation (. Fig. 1d). The PSA level had decreased to 7.4 ng/ ml. The patient reported no pain (VAS score 0/10). He continued the ointment use until the last chemotherapy cycle was finished. The dermatitis did not relapse.
Discussion There are only a few case reports on RRD in the literature as the phenomenon is very rare. Additionally, it occurs sporadically and at present, no predictive factors are known. Nevertheless, RRD has a strong impact on the quality of life of affected patients and may even cause changes in therapy. Therefore, effective and well-tolerated therapy of RRD with an antioxidant ointment may lead to significant benefits for cancer patients. RRD remains a poorly understood phenomenon [1, 10, 21]. Considering that the final common path of RRD is Strahlentherapie und Onkologie 5 · 2014
| 491
Case study
Fig. 1 8 a Simulation X-ray of patient’s 180° irradiation field. b Patient’s back with acute recall dermatitis; pain: VAS 8. c Patient’s back after 5 days of ointment treatment; pain: VAS 2. d Patient’s back 3 weeks after recall dermatitis; pain: VAS 0
free radicals or oxidants as an inflammatory stimulus, we decided to use Mapisal® ointment for the treatment of our patient. In Germany this ointment is authorized for the treatment of hand–foot syndrome in chemotherapy patients, which might be caused by similar mechanisms as RRD. The precise mechanism of RRD is still unknown, and the models for explanation are vague: remembered cell reactions after cytotoxic therapies, mutations generating more vulnerable cells, vascular reactions after radiotherapy, or epithelial stem cell inadequacy are discussed. There is also a suggestion that RRD is a hypersensitivity drug reaction, which seems to be the most likely explanation, as patients show a prompt improvement in symptoms with the discontinuation of drugs [21]. Another point supporting the specific hypersensitivity model is that the risk of RRD is not influenced by whether the patient receives mono- or combination therapy [12]. Especially in cases associated with gemcitabine, recovery from RRD was observed despite the continuation of the drug [12]. In other cases the antitumor or antibiotic therapy had to be changed due to massive skin reactions [19]. However, a facile therapy reliably controlling RRD symptoms without causing new side effects would be an advantage for patients. The ointment used in our patient did not provide a causal treatment, but we achieved the aim of pain relief and could continue systemic tumor therapy. Treat-
492 | Strahlentherapie und Onkologie 5 · 2014
ment with systemic or topical cortisone as recommended in the literature [1, 21] would have caused more side effects and discontinuation of chemotherapy would have affected the patient by compromising the treatment concept. In patients who show RRD, the prophylactic use of antioxidant ointments may allow cancer therapy to be continued without changing medication. Although there is no published evidence, there might be a positive effect of the ointment for patients on radiotherapy too since acute radiation dermatitis has similar pathogenetic mechanisms. This will have to be examined in an appropriate clinical trial. Modern treatment concepts including intensity-modulated radiation therapy (IMRT) involve large skin areas receiving comparably low but still considerable radiation doses [18]. Further, targeted tumor therapies were shown to be feasible in maintenance schedules after chemoradiation [13]. In this context, it seems significant that in the latest literature RRD was described as possibly occurring more often in patients treated with targeted tumor therapies [2, 4, 5, 7, 8, 11, 15]. As these promising therapies should not be interrupted and in many cases the choice of available drugs is limited, an effective treatment of RRD without new side effects or interactions with anticancer agents has to be found. Topical antioxidant ointments seem to be a promising option in this scenario.
Dermatitis is the most common recall phenomenon [21]. For the treatment of other rare recall effects as mucositis or pneumonitis [3, 17, 20] different strategies including systemic treatment have to be developed.
Conclusion RRD is a rare but disturbing phenomenon compromising patients’ quality of life and jeopardizing correct therapy processes. As primary cancer management decisions should not be affected by RRD, an effective symptomatic topical treatment with an antioxidant ointment seems to be recommendable.
Corresponding address Prof. Dr. med. F. Momm Radio-Onkologie Ortenau-Klinikum Offenburg-Gengenbach Lehrkrankenhaus der Albert-LudwigsUniversität Freiburg i. Br., Weingartenstr. 70 77654 Offenburg [email protected] Acknowledgments. We thank medac Gesellschaft für klinische Spezialpräparate mbH, Wedel/Germany, for free Mapisal® ointment. We thank our colleagues Dr. Egger and Dr. Scharr, Department of Internal Medicine, Ortenau-Klinikum Lahr, for the perfect cooperation.
Abstract · Zusammenfassung
Compliance with ethical guidelines
Strahlenther Onkol 2014 ∙ 190:491–493 DOI 10.1007/s00066-014-0609-1 © Springer-Verlag Berlin Heidelberg 2014
Conflict of interest. V. Duncker-Rohr, U. Freund, and F. Momm state that there are no conflicts of interest.
V. Duncker-Rohr · U. Freund · F. Momm
References 1. Baek SW, Seo YJ, Kim JS, Lee HJ (2012) Radiation recall dermatitis after treatment with Paclitaxel and Cisplatin. Ann Dermatol 24:223–224 2. Boussemart L, Boivin C, Claveau et al (2013) Vemurafenib and radiosensitization. JAMA Dermatol 149:855–857 3. Burris HA 3rd, Hurtig J (2010) Radiation recall with anticancer agents. Oncologist 15:1227–1237 4. Chung C, Stuart D, Keyes M (2009) Radiation recall reaction induced by adjuvant trastuzumab (herceptin). Case Rep Med 2009:307894 5. Chung C, Dawson LA, Joshua AM, Brade AM (2010) Radiation recall dermatitis triggered by multi-targeted tyrosine kinase inhibitors: sunitinib and sorafenib. Anticancer Drugs 21:206–209 6. Cox JD, Stetz JA, Pajak TF (1995) Toxicity criteria of the Radiation Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346 7. Dauendorffer JN, Dupuy A (2009) Radiation recall dermatitis induced by erlotinib. J Am Acad Dermatol 61:1086 8. Ford JN, Newton M, Jordan C, Abraham J (2013) Successful rechallenge after ixabepilone-induced radiation recall dermatitis using an alternative dosing strategy. J Oncol Pharm Pract 19:89–92 9. Giesel BU, Kutz GG, Thiel HJ (2001) Recall dermatitis caused by re-exposure to docetaxel following irradiation of the brain. Case report and review of the literature. Strahlenther Onkol 177:487–493 10. Haas RL, de Klerk G (2011) An illustrated case of doxorubicin-induced radiation recall dermatitis and a review of the literature. Neth J Med 69:72– 75 11. Levy A, Hollebecque A, Bourgier C et al (2013) Targeted therapy-induced radiation recall. Eur J Cancer 49:1662–1668 12. Lock M, Sinclair K, Welch S, Younus J, Salim M (2011) Radiation recall dermatitis due to gemcitabine does not suggest the need to discontinue chemotherapy. Oncol Lett 2:85–90 13. Matuschek C, Bölke E, Belka C et al (2013) Feasibility of 6-month maintenance cetuximab after adjuvant concurrent chemoradiation plus cetuximab in squamous cell carcinoma of the head and neck. Strahlenther Onkol 189:625–631 14. Momm F, Bartelt S, Haigis K et al (2005) Spectrophotometric skin measurements correlate with EORTC/RTOG-common toxicity criteria. Strahlenther Onkol 181:392–395 15. Moon D, Koo JS, Suh CO, Yoon CY, Bae J, Lee S (2013) Radiation recall dermatitis induced by trastuzumab. Breast Cancer (Epub ahead of print) 16. Morkas M, Fleming D, Hahl M (2002) Challenges in oncology. Case 2. Radiation recall associated with docetaxel. J Clin Oncol 20:867–869 17. Schwarte S, Wagner K, Karstens JH, Bremer M (2007) Radiation recall pneumonitis induced by gemcitabine. Strahlenther Onkol 183:215–217
Radiation recall dermatitis after docetaxel chemotherapy. Treatment by antioxidant ointment Abstract Radiation recall dermatitis (RRD) is an acute skin toxicity caused by different anticancer or antibiotic drugs within a former completely healed irradiation field. Predictive factors for RRD are not known and its mechanisms are not completely understood. A case of RRD induced by docetaxel and successfully treated by an antioxidant ointment (Mapisal®) is presented here. Such an ointment might be useful not only in RRD therapy, but also in
the treatment of high-grade dermatitis induced by radiotherapy and thus may contribute to the improvement of patients’ quality of life and to the scheduled completion of cancer therapies. Keywords Radiation recall reaction · Dermatitis · Docetaxel · Antioxidant ointment · Radiotherapy
Strahlen-Recall-Dermatitis nach Docetaxel-Chemotherapie. Behandlung mit einer antioxidativen Salbe Zusammenfassung Die Strahlen-Recall-Dermatitis (RRD) ist eine akute Hauttoxizität, die durch verschiedene Chemotherapeutika oder Antibiotika innerhalb eines früheren, komplett abgeheilten Bestrahlungsfelds hervorgerufen wird. Prädiktive Faktoren für die RRD sind nicht bekannt und ihr Mechanismus ist nicht vollständig geklärt. Es wird ein Fallbericht einer durch Docetaxel induzierten RRD dargestellt, die erfolgreich mit einer antioxidativen Salbe (Mapisal®) behandelt wurde. Solche Salben könn-
ten nicht nur zur Therapie der RRD, sondern auch bei der Behandlung einer akuten Dermatitis während der Strahlentherapie nützlich sein und damit zur Verbesserung der Lebensqualität der Patienten und zur planmäßigen Durchführung der Tumortherapie beitragen. Schlüsselwörter Recall-Reaktion · Dermatitis · Docetaxel · Antioxidative Salbe · Strahlentherapie
18. Uzel EK, Karaçam S, Eliçin O, Uzel O (2013) Comparison of two different IMRT planning techniques in the treatment of nasopharyngeal carcinoma. Effect on parotid gland radiation doses. Strahlenther Onkol 189:552–558 19. Wernicke AG, Swistel AJ, Parashar B, Myskowski PL (2010) Levofloxacin-induced radiation recall dermatitis: a case report and a review of the literature. Clin Breast Cancer 10:404–406 20. Wygoda A, Rutkowski T, Hutnik M et al (2013) Acute mucosal reactions in patients with head and neck cancer. Three patterns of mucositis observed during radiotherapy. Strahlenther Onkol 189:547–551 21. Zhu SY, Yuan Y, Xi Z (2012) Radiation recall reaction: two case studies illustrating an uncommon phenomenon secondary to anti-cancer agents. Cancer Biol Med 9:202–204
Strahlentherapie und Onkologie 5 · 2014
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Viola Duncker-Rohr · Ulrich Freund · Felix Momm Radio-Onkologie, Ortenau-Klinikum Offenburg-Gengenbach, Lehrkrankenhaus der Albert-Ludwigs-Universität Freiburg i. Br., Offenburg, Germany
Radiation recall dermatitis after docetaxel chemotherapy Treatment by antioxidant ointment
Introduction
Case report
Radiation recall dermatitis (RRD) is an acute skin toxicity in a former irradiation field completely healed from radiation side effects. It is typically caused by anticancer or antibiotic agents given to the patient weeks, months, or even years after the end of radiotherapy [1, 9, 10, 12, 16, 19, 21]. Skin reactions occurring within 7 days of radiotherapy are thought to be induced by direct radiosensitization. Sufficient quantification of RRD can be obtained by clinical scoring with Common Toxicity Criteria (CTC) [6, 14]. In the literature, stopping the agent causing the dermatitis and starting treatment with local or systemic cortisone medication are recommended for patients with recall effects [21]. Replacing anticancer or antibiotic agents by equivalent alternatives may cause significant problems, as these alternatives might not exist. Cortisone may not be used in patients with infectious diseases or in cancer patients with compromised immune defense. Therefore, an alternative strategy in the treatment of RRD should be developed. The mechanisms of radiation recall occurrence are not completely known [1, 10, 21]. However, some authors propose local free radicals or oxidants as being responsible for recall dermatitis. Therefore, we decided to test an antioxidant ointment (Mapisal®) for the treatment of a patient with RRD caused by docetaxel. In Germany, Mapisal® is authorized for the treatment of chemotherapy-induced hand– foot syndrome, which may be caused by similar pathogenetic effects as RRD.
A 63-year-old Caucasian patient presented with prostate cancer and simultaneous bone metastases (stage cT2c cN0 M1 Gleason score 5 + 5 = 10). The patient’s prostate-specific antigen (PSA) level was 36.25 ng/ml. He received antihormonal and antiandrogen therapy for 6 months as well as monthly denosumab injections. Initially, this therapy worked well and the PSA level decreased. After 6 months, however, the PSA level increased again to 50.83 ng/ml, although the testosterone level was low (0.09 µg/l). The patient reported significant pelvic and spinal pain and progression of the bone metastases was diagnosed. Therefore, we decided for a docetaxel chemotherapy and irradiation of the symptomatic bone metastases. Three cycles of docetaxel at 75 mg/ m2 on day 1, with a repeat on day 22, were given. Parallel to the third cycle of chemotherapy, radiotherapy (five fractions of2 Gy per week, total dose 40 Gy, CTbased 3D planning) to the pelvis and the lumbar spine was given (180° port shown in . Fig. 1a). Due to the radiotherapy, the third chemotherapy cycle was given at a reduced dose (80 %). In spite of parallel chemotherapy, the patient tolerated the radiotherapy well and without any visible skin reaction. After this treatment the PSA level decreased to 29.2 ng/ml and the patient received another three cycles (cycles 4–6) of docetaxel. Following cycle 5, 3 months after completion of radiotherapy, he presented with massive dermatitis of CTC grade 3–4 [6] in the dorsal irradiation field (. Fig. 1b).
He reported great pain, visual analogue scale (VAS) score of 8/10. Self-medication with diclophenac did not result in sufficient, long-lasting pain relief. Considering the erythema was exactly within the 180° radiation field, we diagnosed a radiation recall dermatitis. The patient received the antioxidant ointment Mapisal® for topical use three times per day without any other comedication. Five days later, there was significantly reduced pain (VAS score 2/10) and improvement of acute skin reactions (. Fig. 1c). He reported significant pain relief starting on the first day of ointment use. We decided to continue with chemotherapy. Three weeks later the dermatitis had completely resolved except for a slight hyperpigmentation (. Fig. 1d). The PSA level had decreased to 7.4 ng/ ml. The patient reported no pain (VAS score 0/10). He continued the ointment use until the last chemotherapy cycle was finished. The dermatitis did not relapse.
Discussion There are only a few case reports on RRD in the literature as the phenomenon is very rare. Additionally, it occurs sporadically and at present, no predictive factors are known. Nevertheless, RRD has a strong impact on the quality of life of affected patients and may even cause changes in therapy. Therefore, effective and well-tolerated therapy of RRD with an antioxidant ointment may lead to significant benefits for cancer patients. RRD remains a poorly understood phenomenon [1, 10, 21]. Considering that the final common path of RRD is Strahlentherapie und Onkologie 5 · 2014
| 491
Case study
Fig. 1 8 a Simulation X-ray of patient’s 180° irradiation field. b Patient’s back with acute recall dermatitis; pain: VAS 8. c Patient’s back after 5 days of ointment treatment; pain: VAS 2. d Patient’s back 3 weeks after recall dermatitis; pain: VAS 0
free radicals or oxidants as an inflammatory stimulus, we decided to use Mapisal® ointment for the treatment of our patient. In Germany this ointment is authorized for the treatment of hand–foot syndrome in chemotherapy patients, which might be caused by similar mechanisms as RRD. The precise mechanism of RRD is still unknown, and the models for explanation are vague: remembered cell reactions after cytotoxic therapies, mutations generating more vulnerable cells, vascular reactions after radiotherapy, or epithelial stem cell inadequacy are discussed. There is also a suggestion that RRD is a hypersensitivity drug reaction, which seems to be the most likely explanation, as patients show a prompt improvement in symptoms with the discontinuation of drugs [21]. Another point supporting the specific hypersensitivity model is that the risk of RRD is not influenced by whether the patient receives mono- or combination therapy [12]. Especially in cases associated with gemcitabine, recovery from RRD was observed despite the continuation of the drug [12]. In other cases the antitumor or antibiotic therapy had to be changed due to massive skin reactions [19]. However, a facile therapy reliably controlling RRD symptoms without causing new side effects would be an advantage for patients. The ointment used in our patient did not provide a causal treatment, but we achieved the aim of pain relief and could continue systemic tumor therapy. Treat-
492 | Strahlentherapie und Onkologie 5 · 2014
ment with systemic or topical cortisone as recommended in the literature [1, 21] would have caused more side effects and discontinuation of chemotherapy would have affected the patient by compromising the treatment concept. In patients who show RRD, the prophylactic use of antioxidant ointments may allow cancer therapy to be continued without changing medication. Although there is no published evidence, there might be a positive effect of the ointment for patients on radiotherapy too since acute radiation dermatitis has similar pathogenetic mechanisms. This will have to be examined in an appropriate clinical trial. Modern treatment concepts including intensity-modulated radiation therapy (IMRT) involve large skin areas receiving comparably low but still considerable radiation doses [18]. Further, targeted tumor therapies were shown to be feasible in maintenance schedules after chemoradiation [13]. In this context, it seems significant that in the latest literature RRD was described as possibly occurring more often in patients treated with targeted tumor therapies [2, 4, 5, 7, 8, 11, 15]. As these promising therapies should not be interrupted and in many cases the choice of available drugs is limited, an effective treatment of RRD without new side effects or interactions with anticancer agents has to be found. Topical antioxidant ointments seem to be a promising option in this scenario.
Dermatitis is the most common recall phenomenon [21]. For the treatment of other rare recall effects as mucositis or pneumonitis [3, 17, 20] different strategies including systemic treatment have to be developed.
Conclusion RRD is a rare but disturbing phenomenon compromising patients’ quality of life and jeopardizing correct therapy processes. As primary cancer management decisions should not be affected by RRD, an effective symptomatic topical treatment with an antioxidant ointment seems to be recommendable.
Corresponding address Prof. Dr. med. F. Momm Radio-Onkologie Ortenau-Klinikum Offenburg-Gengenbach Lehrkrankenhaus der Albert-LudwigsUniversität Freiburg i. Br., Weingartenstr. 70 77654 Offenburg [email protected] Acknowledgments. We thank medac Gesellschaft für klinische Spezialpräparate mbH, Wedel/Germany, for free Mapisal® ointment. We thank our colleagues Dr. Egger and Dr. Scharr, Department of Internal Medicine, Ortenau-Klinikum Lahr, for the perfect cooperation.
Abstract · Zusammenfassung
Compliance with ethical guidelines
Strahlenther Onkol 2014 ∙ 190:491–493 DOI 10.1007/s00066-014-0609-1 © Springer-Verlag Berlin Heidelberg 2014
Conflict of interest. V. Duncker-Rohr, U. Freund, and F. Momm state that there are no conflicts of interest.
V. Duncker-Rohr · U. Freund · F. Momm
References 1. Baek SW, Seo YJ, Kim JS, Lee HJ (2012) Radiation recall dermatitis after treatment with Paclitaxel and Cisplatin. Ann Dermatol 24:223–224 2. Boussemart L, Boivin C, Claveau et al (2013) Vemurafenib and radiosensitization. JAMA Dermatol 149:855–857 3. Burris HA 3rd, Hurtig J (2010) Radiation recall with anticancer agents. Oncologist 15:1227–1237 4. Chung C, Stuart D, Keyes M (2009) Radiation recall reaction induced by adjuvant trastuzumab (herceptin). Case Rep Med 2009:307894 5. Chung C, Dawson LA, Joshua AM, Brade AM (2010) Radiation recall dermatitis triggered by multi-targeted tyrosine kinase inhibitors: sunitinib and sorafenib. Anticancer Drugs 21:206–209 6. Cox JD, Stetz JA, Pajak TF (1995) Toxicity criteria of the Radiation Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346 7. Dauendorffer JN, Dupuy A (2009) Radiation recall dermatitis induced by erlotinib. J Am Acad Dermatol 61:1086 8. Ford JN, Newton M, Jordan C, Abraham J (2013) Successful rechallenge after ixabepilone-induced radiation recall dermatitis using an alternative dosing strategy. J Oncol Pharm Pract 19:89–92 9. Giesel BU, Kutz GG, Thiel HJ (2001) Recall dermatitis caused by re-exposure to docetaxel following irradiation of the brain. Case report and review of the literature. Strahlenther Onkol 177:487–493 10. Haas RL, de Klerk G (2011) An illustrated case of doxorubicin-induced radiation recall dermatitis and a review of the literature. Neth J Med 69:72– 75 11. Levy A, Hollebecque A, Bourgier C et al (2013) Targeted therapy-induced radiation recall. Eur J Cancer 49:1662–1668 12. Lock M, Sinclair K, Welch S, Younus J, Salim M (2011) Radiation recall dermatitis due to gemcitabine does not suggest the need to discontinue chemotherapy. Oncol Lett 2:85–90 13. Matuschek C, Bölke E, Belka C et al (2013) Feasibility of 6-month maintenance cetuximab after adjuvant concurrent chemoradiation plus cetuximab in squamous cell carcinoma of the head and neck. Strahlenther Onkol 189:625–631 14. Momm F, Bartelt S, Haigis K et al (2005) Spectrophotometric skin measurements correlate with EORTC/RTOG-common toxicity criteria. Strahlenther Onkol 181:392–395 15. Moon D, Koo JS, Suh CO, Yoon CY, Bae J, Lee S (2013) Radiation recall dermatitis induced by trastuzumab. Breast Cancer (Epub ahead of print) 16. Morkas M, Fleming D, Hahl M (2002) Challenges in oncology. Case 2. Radiation recall associated with docetaxel. J Clin Oncol 20:867–869 17. Schwarte S, Wagner K, Karstens JH, Bremer M (2007) Radiation recall pneumonitis induced by gemcitabine. Strahlenther Onkol 183:215–217
Radiation recall dermatitis after docetaxel chemotherapy. Treatment by antioxidant ointment Abstract Radiation recall dermatitis (RRD) is an acute skin toxicity caused by different anticancer or antibiotic drugs within a former completely healed irradiation field. Predictive factors for RRD are not known and its mechanisms are not completely understood. A case of RRD induced by docetaxel and successfully treated by an antioxidant ointment (Mapisal®) is presented here. Such an ointment might be useful not only in RRD therapy, but also in
the treatment of high-grade dermatitis induced by radiotherapy and thus may contribute to the improvement of patients’ quality of life and to the scheduled completion of cancer therapies. Keywords Radiation recall reaction · Dermatitis · Docetaxel · Antioxidant ointment · Radiotherapy
Strahlen-Recall-Dermatitis nach Docetaxel-Chemotherapie. Behandlung mit einer antioxidativen Salbe Zusammenfassung Die Strahlen-Recall-Dermatitis (RRD) ist eine akute Hauttoxizität, die durch verschiedene Chemotherapeutika oder Antibiotika innerhalb eines früheren, komplett abgeheilten Bestrahlungsfelds hervorgerufen wird. Prädiktive Faktoren für die RRD sind nicht bekannt und ihr Mechanismus ist nicht vollständig geklärt. Es wird ein Fallbericht einer durch Docetaxel induzierten RRD dargestellt, die erfolgreich mit einer antioxidativen Salbe (Mapisal®) behandelt wurde. Solche Salben könn-
ten nicht nur zur Therapie der RRD, sondern auch bei der Behandlung einer akuten Dermatitis während der Strahlentherapie nützlich sein und damit zur Verbesserung der Lebensqualität der Patienten und zur planmäßigen Durchführung der Tumortherapie beitragen. Schlüsselwörter Recall-Reaktion · Dermatitis · Docetaxel · Antioxidative Salbe · Strahlentherapie
18. Uzel EK, Karaçam S, Eliçin O, Uzel O (2013) Comparison of two different IMRT planning techniques in the treatment of nasopharyngeal carcinoma. Effect on parotid gland radiation doses. Strahlenther Onkol 189:552–558 19. Wernicke AG, Swistel AJ, Parashar B, Myskowski PL (2010) Levofloxacin-induced radiation recall dermatitis: a case report and a review of the literature. Clin Breast Cancer 10:404–406 20. Wygoda A, Rutkowski T, Hutnik M et al (2013) Acute mucosal reactions in patients with head and neck cancer. Three patterns of mucositis observed during radiotherapy. Strahlenther Onkol 189:547–551 21. Zhu SY, Yuan Y, Xi Z (2012) Radiation recall reaction: two case studies illustrating an uncommon phenomenon secondary to anti-cancer agents. Cancer Biol Med 9:202–204
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