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 a case of capecitabine-induced Radiation Therapy Oncology Group (RTOG) grade 4 (ulcerating dermatitis) recall skin toxicity of skin irradiated 3 years previously. To our knowledge, this is the first reported case of capecitabine-induced RTOG grade 4 (ulcerating dermatitis) recall skin toxicity of previously irradiated skin. 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 radiation recall phenomenon after the administration of capecitabine, consisting of pain, hyperpigmentation, and ulceration in the field of post-mastectomy irradiation
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 [tocopheryl acetate, disodium EDTA, silybum marianum, vitis vinifera] three times a day)
Three months later in July 2010, she was noted to have rapidly developed a series of ulcers on the previous mastectomy scar, which had changed in colour and elasticity over the skin of the previously irradiated area in the left hemithorax (Figure 1)
Summary
We report a case of radiation recall phenomenon after the administration of capecitabine, consisting of pain, hyperpigmentation, and ulceration in the field of post-mastectomy 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 six months with a good local response as measured by ultrasound scanning. 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 [tocopheryl acetate, disodium EDTA, silybum marianum, vitis vinifera] three times a day) She started letrozole 2.5 mg/d again in January 2007. All active medication was stopped in May that year and palliative care lasted until the patient passed away a few months afterwards
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