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The authors present a case of radiation recall dermatitis occurring in a patient receiving paclitaxel shortly after completion of radiation therapy. A brief review of previously reported taxane-induced radiation recall reactions is provided.
BACKGROUND: Several cases of long term radiation sequelae have been reported in patients with lupus erythematosus and systemic sclerosis after breast or chest wall irradiation. To the authors' knowledge, no experience with such complications in patients with mixed connective tissue disease (MCTD) has been reported previously. METHODS: A case of a woman with occult breast carcinoma metastatic to the axilla and preexisting MCTD is presented. To the authors' knowledge, this is the first case report of the adverse effects of breast irradiation in a patient with MCTD. The pathophysiology of such radiation injury to specific anatomic structures and technical dosimetric considerations of the radiation therapy and radiation dose are analyzed. The relevant literature on other collagen vascular diseases with features related to MCTD is reviewed. RESULTS: A moderate dose of radiation to the breast and regional lymphatics resulted in marked early and late toxicity to skin and subcutaneous tissues. The tissue injury was similar to that observed in patients with lupus erythematosus and systemic sclerosis. The early skin reaction (moist desquamation) was related to the daily radiation dose delivered at the depth of the epidermis, and the late reaction (subcutaneous fibrosis) was related to the dose at the depth of the dermal capillaries and dermal connective tissue. CONCLUSIONS: Patients with MCTD may develop exaggerated radiation reactions similar to those in patients with lupus erythematosus and systemic sclerosis. Although the incidence of such radiation reactions in patients with MCTD is difficult to assess, the risks and benefits of radiation therapy should be carefully weighed in these patients, particularly if an alternative therapy is available. If there is no alternative, judicious attention to radiotherapy technique may reduce or prevent skin toxicity.
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The clinical courses of 418 patients with breast carcinoma who received postradical-mastectomy radiation therapy to the internal mammary and supraclavicular are were revied in order to determine the normal tissue tolerance with various time-dose fractionation radiation regimens. Four different dose fractionation schedules wereemplyed during the period 1958-1968 at Memorial Hospital: 4900 rads/10f/32d; 4410 rads/9f/30d; 5000 rads/13f/18d; and 4600 rads/20f/28d. There was no difference in the acute reaction or local recurrence rate of the tumor in the irradiated area among the four fractionation schemes, but the late effects were quite different. Patients who received 4900 rads in 10 fractions in 32 days had a 33% incidence of subcutaneous fibrosis.A similiar dose in 13 fractions in 21/2-3 weeks resulted in about 17% subcutaneous fibrosis. No significance of these clinical findings is discussed in relation to the various formulae currently being used to express time-dose equivalence.
BACKGROUND: Radiation port dermatophytosis (RPD) is an uncommon condition in which patients receiving radiation therapy concurrently have tinea corporis that is confined primarily to the irradiated skin. METHODS: The case of a 33-year-old man is reported who was receiving cobalt-60 radiation therapy for a nasopharyngeal carcinoma. During therapy, a dermatophyte infection developed in the treated field. RESULTS: Including this patient, there have been only three cases of RPD reported in the world literature. The clinical characteristics of patients with RPD are reviewed. The diagnosis, management, and pathogenesis of this condition are discussed. CONCLUSIONS: Because the cutaneous manifestations of RPD may be misinterpreted clinically as acute radiation-induced dermatitis, this condition may be more prevalent than the paucity of published reports suggests.
Dose measurements were performed with an ionization chamber placed on the surface of a polystyrene phantom to estimate the radiation dose to the skin from fluoroscopy in patients undergoing PTCA and to define parameters predicting for high-risk irradiation conditions. Dose rate changes were analyzed as a function of phantom thickness, X-ray source-to-phantom distance, image intensifier-to-phantom distance, and field size. Skin dose calculations were made in 38 PTCA patients to validate the model. Thickness was the most important factor determining dose rate changes in the phantom's surface. Dose rate increased by a factor of almost 4 with each 10-cm increment in thickness, doubled upon decreasing the field diameter from 17 cm to 14 cm, and increased by a factor of 1.2 to 1.8 upon decreasing the source-to-phantom distance or by increasing the image intensifier-to-patient distance. All these parameters may significantly increase the dose to the skin and augment the risk for skin injuries post-PTCA.
BACKGROUND: Radiation recall reactions, in particular dermatitis, are well documented in the literature. However, radiation recall mucositis is a rare clinical phenomenon. METHODS: We report a case of a 45-year-old man diagnosed with squamous cell carcinoma of the base of tongue. He was treated with surgery followed by chemotherapy and radiation therapy. Several months after completing treatment, he had a recurrence develop outside of the previously irradiated field. He was offered radiation therapy concurrent with docetaxel as salvage therapy. RESULTS: During salvage therapy, acute recall mucositis developed corresponding to his previously irradiated fields. His chemotherapy with docetaxel was withheld, and his symptoms rapidly improved. CONCLUSIONS: This case describes radiation recall mucositis associated with docetaxel, a rare but potentially serious clinical situation. Given the potential severity of the reaction and increasing use of docetaxel as second-line treatment of recurrent head and neck cancers, it is important to be aware of this phenomenon.
Superficial irradiation results in well recognized late sequelae including not only sclerosis and atrophy of skin and subcutaneous tissue, but also the development of benign and malignant tumors of skin and adjacent structures. The long latency between irradiation and its late effects allowed the early uncontrolled use of radiation treatment for benign conditions. The subsequent recognition of the causal relationship between tumors and previous irradiation has restricted its use to more appropriate purposes, although it is possible that it is still overused in some areas of dermatologic practice. Clinicians need to be aware of the time interval between irradiation and the development of its late sequelae, and the incidence of these sequelae. Appropriate irradiation exposure history should be a part of the evaluation of every patient.
PDT has been shown to be of value in inoperable basal and squamous skin cancers and in cutaneous metastases. Azone, a new investigative vehicle for HpD, is of value more for intralesional injections than for topical applications in tumors, except perhaps for superficial mucous membrane lesions. The more flexible gold head vapor is of definite value in the PDT program. For test models for PDT studies in dermatology and plastic surgery with HpD and other fluorochromes, single thickened resistant plaques of psoriasis and the common baso squamous acanthoma (seborrheic warty growth) have been used. In all these studies, adequate controls are necessary.
OBJECTIVE: Postoperative radiotherapy (RT) is the most used adjuvant treatment in high risk endometrial cancer (HREC), and it appears to reduce the incidence of pelvic relapses but doesn't seem to improve survival. Paclitaxel (P) has shown in vitro and clinical activity against endometrial cancer, and it is also a potent radiosensitizer by blocking dividing cells in G2/M phase. This is the first study that verifies the feasibility of a treatment with concomitant weekly chemotherapy and RT to potentially reduce the incidence of local and distant relapses in order to improve survival in HREC. PATIENTS AND METHODS: Thirteen patients with HREC have entered the feasibility study at San Raphael Hospital University of Milan. All patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and surgical staging. Four patients presented stage IC disease, 2 women had IIB stage tumors, 5 patients revealed IIIA stage disease, and 2 had stage IIIC. The patients received P (60 mg./m(2)) via a continuous 1-h infusion once weekly during the 5 weeks of RT (mean radiation dose of 50.4 Gy). At the end of RT three additional consolidation courses of P (80 mg/m(2)) were subministered. Eleven patients received only pelvic irradiation; in 2 cases radiotherapy was performed on an extended field. RESULTS: Eleven of the 13 enrolled patients have completed the radiochemotherapy regimen. A total of 100 courses of P were performed. All patients completed the RT. Adverse effects were evaluated. Hematological toxicity was mild: four cycles (4%) were delayed 1 week because of grade 1 neutropenia. No severe thrombocytopenia was identified. No hemotrasfusions were performed. One cycle was delayed for fever. Gastrointestinal adverse effects were observed in 2 patients, in which the cycles were delayed 1 week because of diarrhea. One cycle was delayed 1 week because of dermatitis. One patient developed a subocclusion 8 weeks after the end of the treatment, with medical resolution. No patients developed hypersensitivity reactions. CONCLUSIONS: Concomitant P and RT is safe and acceptable treatment in patients with HREC. Prospective clinical studies are necessary to evaluate the benefits of this regimen for the long-term survival rate.
The response of skin to irradiation is highly complex and is dependent on many radiation-related, patient-related, and treatment-related factors. No standardized treatment of skin reactions related to radiation exists at this time. Ongoing research studying acute and late skin effects works to minimize reactions and improve patient quality-of-life. However, research with strong methodology is needed to determine if any management strategy is superior.
The scar tissue carcinoma is a rare disease which arises from the floor of unstable scars, chronic fistulae, ulcera and radiation injuries. The clinical pictures of 23 cases between 1976 and September 1990 have been elucidated. Compared to earlier findings it must now be stated that the development of cancer in stasis ulcera is more frequent than in burn scars or X-ray cancer. Generally, the number of scar tissue carcinomas seems to decrease. Since surgical and adjuvant therapies are--like in any other cancers--limited, prevention and early diagnosis have become of major importance. Though the cancer grows mainly on the body surface and could, therefore, be easily recognised, we still found tumours of remarkable dimension and disturbance, which were either shown to the physician too late or remained unrecognised by the diagnostician.
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Between October 1989 and January 1991 five children with brain stem tumors were treated with sequential chemo- and radiotherapy. The polychemotherapy consisted of procarbazine, ifosfamide, etoposide, methotrexate, cisplatin and cytosine arabinoside. Locally, hyperfractionated radiotherapy was delivered at a total dose of 63.8 Gy (1.1 Gy twice daily, 10 fractions per week). After a median observation time of 11.8 (range 4-23) months from diagnosis three children are alive and without evidence of tumor progression. Two patients died from tumor progression 11 and 16 months respectively after initiation of therapy.
Anti-inflammatory effects of eicosapentaenoic (EPA) and docosahexaenoic acids (DHA) were examined on three models of skin inflammation induced in mice by topical application of an arachidonic acid (AA) solution, ultraviolet-B (UVB) irradiation, and contact sensitization with dinitrofluorobenzene. Ear oedema reactions induced by AA and UVB irradiation were significantly suppressed in mice fed a daily dose of 300 mg/kg EPA for 2 weeks. The contact hypersensitivity reaction was not impaired by EPA. None of the skin reactions was significantly inhibited in mice fed DHA or safflower oil. The results suggest that EPA, but not DHA, has anti-inflammatory effects on AA- and UVB-induced acute inflammation reactions.
Time course and dose-response relationships have been studied for medium-wave ultraviolet radiation (UVB) in the mouse by measuring the inflammatory oedema of tail tissue. The time course was shown to be dose dependent, larger doses peaking earlier than smaller ones. For intermediate doses the reaction culminated after 48 h. Dose-response curves were sigmoid-shaped with good linear correlation in the region of maximal slope. The dose-response curve was studied at varying intervals after irradiation and the relationship could be shown to be time dependent. UVB differs in some of these respects from phototoxic reactions to chlorpromazine and 8-methoxypsoralen.
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