Concomitant Radiation Recall Dermatitis and Organizing Pneumonia following Breast Radiotherapy: A Case Report

Purpose: Radiation recall dermatitis (RRD) is a rare complication that occurs after completion of radiation therapy (RT) and initiation of a precipitating agent, most commonly chemotherapeutic medications. Various theories attempt to explain the mechanism, including activation of the body’s inflammatory pathways through nonimmune activation. Likewise, radiation-induced organizing pneumonia (RIOP) is an infrequent but potentially life-threatening complication of RT that, while not fully understood, is suspected to be partly an autoimmune reaction. Patient: We present the case of a 71-year-old female with a history of type 2 diabetes mellitus, hypothyroidism, interstitial cystitis, and osteoarthritis who presented with clinical stage T1N0M0 ER+/PR–/HER2– invasive ductal carcinoma of the lower outer quadrant of the left breast, for which she underwent left segmental mastectomy and sentinel lymph node biopsy followed by completion axillary lymph node dissection. Her final pathologic stage was T1N1M0. Result: The patient developed RRD and later RIOP following receipt of radiation and chemotherapy, which resolved with steroid administration. Conclusions: The rarity of both RRD and RIOP occurring in a patient, as in our case, suggests a shared pathophysiology behind these two complications. As both reactions involve some degree of inflammation and respond to corticosteroids, it seems likely that the etiologies of RRD and RIOP lie within the inflammatory pathway. However, further investigation should evaluate the frequency, duration, and triggering of concomitant RRD and RIOP.

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Trastuzumab induced radiation recall dermatitis: an interesting case

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20184868 ◽

2018 ◽

Vol 7 (12) ◽

pp. 2465

Author(s):

Anupama C. ◽

Anuradha H. V. ◽

Vinayak V. Maka

Keyword(s):

Ductal Carcinoma ◽

Growth Factor Receptor ◽

Radical Mastectomy ◽

Left Breast ◽

Interesting Case ◽

Axillary Lymph ◽

Radiation Recall ◽

Skin Reactions ◽

Radiation Recall Dermatitis ◽

Recall Dermatitis

Radiation recall dermatitis (RRD) is the appearance of skin reactions in previously irradiated skin which is triggered by the administration of certain drugs. Surgery, chemotherapy, and radiotherapy are the mainstay of treatment in breast cancer. RRD induced by trastuzumab has been rarely reported in India. This is a case report of a 56-year-old woman presented to the medical oncology outpatient department of our hospital with breast lump, and she was diagnosed to have human epidermal growth factor receptor 2 (HER-2/neu) positive invasive ductal carcinoma of left breast of stage T2N3cM0. She was treated with neoadjuvant chemotherapy, and she underwent modified radical mastectomy with axillary lymph node dissection. The treating oncologist was planned to start on adjuvant chemotherapy with injection trastuzumab for every four weeks, for 15 cycles. Patient received first dose of injection trastuzumab (450 mg) intravenously in the right (contralateral) arm and developed painful, swollen, erythematous blisters, and maculopapular rashes following the sharp linear borders of her previous radiation fields. She was reviewed by the medical oncologist and diagnosed as a rare case of RRD and treated with topical betamethasone cream. Causality assessment for RRD to trastuzumab was done using Naranjo and WHO-UMC scale and found to be in the category of probable and probable/ likely respectively.

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Radiation recall dermatitis after treatment of stage IV breast cancer with nivolumab: a case report

Immunotherapy ◽

10.2217/imt-2019-0020 ◽

2020 ◽

Vol 12 (2) ◽

pp. 123-130 ◽

Cited By ~ 1

Author(s):

Cole Billena ◽

Shilpa Padia ◽

Bridget O’Brien ◽

Jeanna Knoble ◽

Abhay Gokhale ◽

...

Keyword(s):

Breast Cancer ◽

Ductal Carcinoma ◽

Spinal Metastasis ◽

Radical Mastectomy ◽

Multidisciplinary Teams ◽

Adjuvant Radiation ◽

Radiation Recall ◽

Stage Iv Breast Cancer ◽

Radiation Recall Dermatitis ◽

Recall Dermatitis

Radiation recall dermatitis (RRD) is an uncommon dermatologic reaction provoked notably by chemotherapy in an area of skin irradiated weeks to years prior. We report a case of RRD with nivolumab in a woman with breast cancer. The patient was diagnosed with invasive ductal carcinoma of the left breast with an isolated spinal metastasis approached in an oligometastatic fashion with neoadjuvant chemotherapy, modified radical mastectomy and adjuvant radiotherapy. Unfortunately, after progression of bony metastases treated with radiotherapy, the patient received nivolumab and subsequently developed a rash corresponding to the adjuvant radiation field. This case highlights the unpredictable nature and characteristic rash of RRD. It is an important differential diagnosis for multidisciplinary teams who also see chemotherapy-induced dermatitis and immune-related adverse events.

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Recurrent radiation recall dermatitis 40 years after radiation therapy for breast cancer

The Breast Journal ◽

10.1111/tbj.14212 ◽

2021 ◽

Author(s):

Muhammad F. Jamaluddin ◽

Aswin G. Abraham ◽

Geetha Menon ◽

Thomas Nakatsui ◽

Wilson Roa

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Radiation Recall ◽

Radiation Recall Dermatitis ◽

Recall Dermatitis

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A case of potential radiation recall dermatitis induced by chemotherapy, following low-dose total-skin electron beam therapy

European Journal of Dermatology ◽

10.1684/ejd.2019.3670 ◽

2019 ◽

Vol 29 (6) ◽

pp. 671-672 ◽

Cited By ~ 1

Author(s):

Carl Lamoureux ◽

Emilie Gerard ◽

Nora Ouhabrache ◽

Feyrouz Toukal ◽

Anne Pham-Ledard ◽

...

Keyword(s):

Electron Beam ◽

Low Dose ◽

Radiation Recall ◽

Electron Beam Therapy ◽

Radiation Recall Dermatitis ◽

Recall Dermatitis

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Radiation recall dermatitis and pneumonitis induced by trastuzumab (Herceptin®)

International Journal of Dermatology ◽

10.1111/j.1365-4632.2012.05788.x ◽

2013 ◽

Vol 53 (3) ◽

pp. e159-e160 ◽

Cited By ~ 7

Author(s):

Hae Eul Lee ◽

Nam Ji Jeong ◽

Young Lee ◽

Young Joon Seo ◽

Chang Deok Kim ◽

...

Keyword(s):

Radiation Recall ◽

Radiation Recall Dermatitis ◽

Recall Dermatitis

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Clinicopathological Follow-up of Breast DCIS Diagnosed on Biopsies: A Single Institutional Study of 575 Patients

International Journal of Surgical Pathology ◽

10.1177/10668969211012088 ◽

2021 ◽

pp. 106689692110120

Author(s):

Mingfei Yan ◽

Phillip Bomeisl ◽

Hannah Gilmore ◽

Aparna Harbhajanka

Keyword(s):

Lymph Node ◽

Axillary Lymph Node ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Univariate Analysis ◽

Her2 Status ◽

Axillary Lymph ◽

Her2 Amplification ◽

Therapeutic Implications ◽

Microinvasive Carcinoma

Stratifying ductal carcinoma in situ (DCIS) patients into different upgrading risk groups is important in exploiting more precise therapeutic options. Evaluation of estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (ER/PR/HER2) status and axillary lymph node metastatic status for DCIS and their upgraded invasive counterparts can also provide diagnostic and therapeutic implications. We retrospectively studied 575 patients with first-time diagnosis of DCIS on biopsies, and followed up their final diagnosis, ER/PR/HER2 status, and axillary lymph node involvement on excisions. As a result, biopsy-diagnosed DCIS had an overall 19.1% risk to be upgraded on subsequent excisions, with 4.7% being upgraded to microinvasive carcinoma (pT1mi) and 14.4% to overt invasive carcinoma (⩾pT1a). Factors significantly associated with higher upgrading risk on multivariate analysis include biopsy guidance by ultrasound ( P <.001), DCIS with suspicious microinvasion ( P < .001), and DCIS diagnosed in left breast ( P = .026). DCIS diagnosed in younger patients (⩽40 years old) or DCIS with high nuclear grade showed higher upgrading risk only on univariate analysis. About 80% ER + /PR + and ER−/PR− DCIS remained the same ER/PR status after being upgraded, and ER + /PR − DCIS had the highest risk (63.6%) of having HER2 amplification in upgraded invasive carcinoma. For upgraded DCIS, microinvasive carcinoma was more likely to have HER2 amplification (50%) than overt invasive carcinoma (29.5%). Besides, pure DCIS had a low risk of axillary lymph node macrometastasis (0.74%), while the risk increased in DCIS with microinvasion (4.4%) and was highest in overt invasive carcinoma (14.7%). The findings of this study are clinically relevant with respect to criteria that might be used in selecting patients for de-escalation trials.

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Radiation Recall Dermatitis Secondary to Dactinomycin

Pediatric Dermatology ◽

10.1111/pde.12903 ◽

2016 ◽

Vol 33 (5) ◽

pp. e278-e279 ◽

Cited By ~ 2

Author(s):

Brea Prindaville ◽

Kimberly A. Horii ◽

Kristi M. Canty

Keyword(s):

Radiation Recall ◽

Radiation Recall Dermatitis ◽

Recall Dermatitis

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Radiation Recall Dermatitis in Patients Treated with Sorafenib

Case Reports in Oncological Medicine ◽

10.1155/2018/2171062 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Keyur Mehta ◽

Andreas Kaubisch ◽

Justin Tang ◽

Aneesh Pirlamarla ◽

Shalom Kalnicki

Keyword(s):

Chemotherapeutic Agent ◽

Review Of The Literature ◽

Radiation Recall ◽

Case Presentation ◽

Palliative Radiation Therapy ◽

Metastatic Hepatocellular Carcinoma ◽

Radiation Recall Dermatitis ◽

Recall Dermatitis ◽

The Right ◽

Carcinoma Lesion

Introduction. Radiation recall dermatitis (RRD) is a phenomenon that occurs in previously irradiated areas shortly after administration of a chemotherapeutic agent. As the use of sorafenib expands, the incidence of radiation recall dermatitis induced by sorafenib will likely increase. Here, we report on a patient who developed RRD and describe his clinical characteristics along with a review of the literature. Case Presentation. Our patient was treated with palliative radiation therapy (RT) to a painful metastatic hepatocellular carcinoma lesion in the right forearm. He completed his radiation course with grade 1 dermatitis, which had resolved by the time he was started on sorafenib 400 mg twice daily 7 days afterwards. On the 21st day after RT, he presented with desquamation and erythema in the previously irradiated area of the right forearm, consistent with RRD. The sorafenib was discontinued and his symptoms subsequently resolved with conservative topical management. Conclusions. Although the pathophysiologic mechanism of sorafenib-related radiation recall dermatitis remains to be investigated, practitioners should be aware of its presence and management in order to improve clinical outcomes.

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