Abstract
Radiation recall dermatitis is defined as an inflammatory reaction of the skin at the site of previous irradiation. Different drugs have been associated with triggering this phenomenon, and it can also affect other areas and organs where previous radiotherapy has been administered. The time gap between the inflammatory reaction and previous radiation can range from days to several years. We report what we believe to be the first case of Capecitabine-induced Radiation Therapy Oncology Group (RTOG) Grade 4 recall skin toxicity (ulcerating dermatitis), which occurred three years after skin irradiation. Clinicians should be aware of this phenomenon, even when considering patients for whom it has been a long time since previous radiation therapy. This unusual and late drug side effect should be borne in mind in the differential diagnosis and management of advanced-disease patients as it may be confused with local relapse or infectious complication of previously operated areas.
Highlights
We report a case of a radiation recall phenomenon after the administration of Capecitabine, consisting of pain, hyperpigmentation, and ulceration in the field of postmastectomy irradiation
Pathology reported a 6 cm in diameter infiltrating ductal carcinoma pT4dN2a positive for both estrogen and progesterone receptors, and Her2-neu negative. After surgery she started on chemotherapy (Taxol 80 mg/m2 on a weekly schedule for 4 weeks) and adjuvant radiotherapy (50 Gy over left hemithorax and supraclavicular nodes in February 2007)
After initial radiotherapy, in 2007, she developed skin toxicity Radiation Therapy Oncology Group (RTOG) grade 2, which was successfully managed with topical medication (Radiocrem® Rotthafarm SL. 3 times a day)
Summary
We report a case of a radiation recall phenomenon after the administration of Capecitabine, consisting of pain, hyperpigmentation, and ulceration in the field of postmastectomy irradiation (which the patient received 3 years previously). Case report A 78-year old woman allergic to salicylics was diagnosed with a T4dN3M0 (American Joint Committee on Cancer) infiltrating ductal left breast carcinoma (inflammatory breast cancer) in March 2006. Owing to her general condition and advanced local disease, she was initially treated with primary hormonotherapy consisting of Letrozole 2.5 mg/d over a period of 6 months with a good local response as measured by ultrasound scanning. Pathology reported a 6 cm in diameter infiltrating ductal carcinoma pT4dN2a positive for both estrogen and progesterone receptors, and Her2-neu negative After surgery she started on chemotherapy (Taxol 80 mg/m2 on a weekly schedule for 4 weeks) and adjuvant radiotherapy (50 Gy over left hemithorax and supraclavicular nodes in February 2007). She remains on Tamoxifen treatment, and the disease is stable
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