■辐射召回性皮炎(RRD)是局部药物引起的炎性皮肤反应,仅发生在电离辐射停止数月至数年后的先前照射部位。RRD的症状可以从轻度发红到广泛的皮炎。抗肿瘤药物如阿霉素,多西他赛,紫杉醇,和吉西他滨最常与放射回忆反应相关。这些反应也可与抗生素和抗结核药物一起发生。
方法:一名38岁女性,激素受体阴性,HER2阳性炎性乳腺癌(右),临床分期cT4dN1Mx,每隔3周接受AC>TH方案的新辅助化疗(蒽环类抗生素-阿霉素加环磷酰胺X4个周期,然后多西他赛加曲妥珠单抗X4个周期),然后进行改良根治术,然后进行局部辅助放疗。她在手术和放疗开始前接受了第5周期和第6周期曲妥珠单抗单药治疗,分别。放疗完成1个月后,在她的第七周期曲妥珠单抗单一疗法中,她出现轻度水肿和红斑改变在以前的照射区域发烧。进行皮肤活检以排除任何复发;然而,没有发现恶性肿瘤的证据.
■我们将其诊断为RRD病例。我们保守地管理她。稍后,她在随后的周期中接受了相同剂量的全身性类固醇覆盖,她很好地忍受了,除了在每个周期的维持剂量曲妥珠单抗后出现轻度红斑。
结论:辐射召回性皮炎是一种极为罕见的现象;因此,临床医生对这种罕见实体的认识对于及时诊断和适当管理至关重要.
UNASSIGNED: Radiation recall dermatitis (RRD) is a localized drug-induced inflammatory skin reaction occurring exclusively in a previously irradiated site months to years after discontinuation of ionizing radiation. The symptoms of RRD can range from mild redness to extensive dermatitis. Antineoplastic drugs such as doxorubicin, docetaxel, paclitaxel, and gemcitabine are most commonly associated with radiation recall reactions. These reactions can also occur with antibiotics and anti-tubercular drugs.
METHODS: A 38-years-old woman with hormone receptor-negative, HER2-positive inflammatory breast cancer (right), clinical stage cT4dN1Mx, received neoadjuvant chemotherapy with AC > TH protocol at 3 weeks intervals (Anthracycline-Doxorubicin plus Cyclophosphamide X 4 cycles, then docetaxel plus
Trastuzumab X 4 cycles) followed by modified radical mastectomy followed by adjuvant locoregional radiotherapy. She received the 5th cycle and 6th cycle
trastuzumab monotherapy just before the start of surgery and radiotherapy, respectively. After 1 month of completion of radiotherapy, during her seventh cycle of
Trastuzumab monotherapy, she developed mild edema with erythematous change over the previously irradiated area with fever. A skin biopsy was taken to exclude any recurrence; however, no evidence of malignancy was found.
UNASSIGNED: We diagnosed it as a
case of RRD. We managed her conservatively. Later, she was rechallenged with the same dose in subsequent cycles with systemic steroid coverage, which she tolerated very well, except for the reappearance of mild erythema following each cycle of maintenance dose of
Trastuzumab.
CONCLUSIONS: Radiation recall dermatitis is an extremely rare phenomenon; hence, an acquaintance of clinicians with this rare entity is essential for timely diagnosis and appropriate management.