Radyasyon Recall (RR) Sendromu
Özet
Radyasyon Recall (RR) Sendromu, daha önce radyoterapi uygulanmış anatomik bölgelerde, genellikle antineoplastik ilaçlar veya diğer sistemik ajanların tetiklemesiyle meydana gelen ender ve öngörülemeyen bir inflamatuar reaksiyondur. Klinik olarak akut radyasyon reaksiyonlarının tamamlanmasından en az yedi gün sonra ortaya çıkmasıyla radyosensitizasyondan ayırt edilen bu durum, aylar hatta yıllar sonra bile tetiklenebilir. En sık ciltte hafif veya şiddetli dermatit formunda gözlense de akciğer, yemek borusu, gastrointestinal sistem ve kas dokusu gibi iç organları da etkileyebilmektedir. Özellikle antrasiklinler, taksanlar ve antimetabolitler gibi sitotoksik ilaçlarla ilişkili olan bu sendromun patofizyolojisi net olmamakla birlikte; kök hücre fonksiyonlarındaki değişimler, radyasyonun inflamasyon eşiğini düşürmesi ve lokal sitokin salınımı gibi mekanizmalar öne sürülmektedir. Vakaların teşhisi genellikle hastanın tedavi öyküsü ve fiziksel muayenesiyle konulur ve iç organ tutulumlarında radyolojik görüntülemeden yararlanılır. Tedavide temel yaklaşım tetikleyici ajanın kullanımına ara verilmesi veya tamamen kesilmesi olup, semptomların şiddetine göre topikal veya sistemik kortikosteroidler ile antihistaminikler tercih edilmektedir. Riskleri en aza indirmek için radyoterapi ile kemoterapi arasındaki sürenin uzatılması ve doz optimizasyonu önerilmektedir.
Radiation Recall (RR) Syndrome is a rare and unpredictable inflammatory reaction that occurs in previously irradiated tissues, typically triggered by the subsequent administration of systemic antineoplastic agents. Differentiated from radiosensitization by a time interval of seven days or more after the completion of radiotherapy, this phenomenon can manifest weeks, months, or even years later. Although it most frequently presents as cutaneous dermatitis ranging from mild erythema to severe necrosis, it can also affect internal organs such as the lungs, esophagus, gastrointestinal tract, and muscle tissue, with certain drugs like gemcitabine predominantly involving internal structures. The exact pathophysiology remains unproven, but hypotheses include radiation-induced stem cell alterations, lowered inflammatory thresholds, localized hypersensitivity, and persistent cytokine release. Commonly associated with cytotoxic agents like anthracyclines, taxanes, and antimetabolites, RR is diagnosed primarily through clinical history and physical examination. Management requires pausing or permanently discontinuing the offending drug, as spontaneous resolution is rare during continued treatment. While no definitive predictive tools exist, minimizing radiation doses and extending the interval between radiotherapy and chemotherapy are recommended strategies to lower the risk of developing this potentially severe syndrome.
Referanslar
Eckardt M, Bean A, Selch M, Federman N, A Child With Gemcitabine-induced Severe Radiation Recall Myositis Resulting in a Compartment Syndrome, J Pediatr Hematol Oncol 2013;35:156–161
D’Angio GJ, Farber S, Maddock CL. Potentiation of x-ray effects by actinomycin D. Radiology 1959;73:175–177.
Camidge R, Price A. Characterizing the phenomenon of radiation recall dermatitis. Radiother Oncol 2001;59:237–245.
Howard A. Burris I, Hurtig J, Radiation Recall with Anticancer Agents, The Oncologist, 2010;15:1227–1237
Yeo W, Johnson PJ. Radiation-recall skin disorders associated with the use of antineoplastic drugs. Pathogenesis, prevalence, and management. Am J Clin Dermatol 2000;1:113–116.
Kodym E, Kalinska R, Ehringfeld C et al. Frequency of radiation recall dermatitis in adult cancer patients. Onkologie 2005;28:18–21.
Haffty BG, Vicini FA, Beitsch P et al. Timing of Chemotherapy after MammoSite radiation therapy system breast brachytherapy: analysis of the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Int J Radiat Oncol Biol Phys 2008;72:1441–1448.
Saif MW, Black G, Johnson M et al. Radiation recall phenomenon secondary to capecitabine: possible role of thymidine phosphorylase. Cancer Chemother Pharmacol 2006;58:771–775.
Mizumoto M, Harada H, Asakura H et al. Frequency and characteristics of docetaxel-induced radiation recall phenomenon. Int J Radiat Oncol Biol Phys 2006;66:1187–1191.
Kitani H, Kosaka T, Fujihara T et al. The “recall effect” in radiotherapy: is subeffective, reparable damage involved? Int J Radiat Oncol Biol Phys 1990;18:689–695.
Smith KJ, Germain M, Skelton H. Histopathologic features seen with radiation recall or enhancement eruptions. J Cutan Med Surg 2002;6:535–540.
Ortmann E, Hohenberg G. Treatment side effects. Case 1. Radiation recall phenomenon after administration of capecitabine. J Clin Oncol 2002;20: 3029–3030.
Bronner AK, Hood AF. Cutaneous complications of chemotherapeutic agents. J Am Acad Dermatol 1983;9:645–663.
Burdon J, Bell R, Sullivan J et al. Adriamycin-induced recall phenomenon 15 years after radiotherapy. JAMA 1978;239:931.
Barle´si F, Tummino C, Tasei AM et al. Unsuccessful rechallenge with pemetrexed after a previous radiation recall dermatitis. Lung Cancer 2006;54: 423–425.
Friedlander PA, Bansal R, Schwartz L et al. Gemcitabine-related radiation recall preferentially involves internal tissue and organs. Cancer 2004;100: 1793–1799.
Saif MW, Ramos J, Knisely J. Radiation recall phenomenon secondary to bevacizumab in a patient with pancreatic cancer. JOP 2008;9:744–747.
Stelzer KJ, Griffin TW, Koh WJ. Radiation recall skin toxicity with bleomycin in a patient with Kaposi sarcoma related to acquired immune deficiency syndrome. Cancer 1993;71:1322–1325.
George J, Saif MW, Truss C. Radiation recall phenomenon, manifested as diffuse gastritis and upper gastrointestinal bleed after capecitabine administration. J Appl Res 2004;4:495–498.
Borroni G, Vassallo C, Brazzelli V et al. Radiation recall dermatitis, panniculitis, and myositis following cyclophosphamide therapy: histopathologic findings of a patient affected by multiple myeloma. Am J Dermatopathol 2004;26:213–216.
Wallenborn PA III, Postma DS. Radiation recall supraglottitis. A hazard in head and neck chemotherapy. Arch Otolaryngol 1984;110:614–617.
Kennedy RD, McAleer JJ. Radiation recall dermatitis in a patient treated with dacarbazine. Clin Oncol (R Coll Radiol) 2001;13:470–472.
D’Angio GJ. Clinical and biologic studies of actinomycin D and roentgen irradiation. Am J Roentgenol Radium Ther Nucl Med 1962;87:106–109.
Camidge DR, Kunkler IH. Docetaxel-induced radiation recall dermatitis and successful rechallenge without recurrence. Clin Oncol (R Coll Radiol) 2000;12:272–273.
Stein RS. Radiation-recall enteritis after actinomycin-D and adriamycin therapy. South Med J 1978;71:960–961.
Cassady JR, Richter MP, Piro AJ et al. Radiation-adriamycin interactions:preliminary clinical observations. Cancer 1975;36:946–949.
Perez EA, Campbell DL, Ryu JK. Radiation recall dermatitis induced by edatrexate in a patient with breast cancer. Cancer Invest 1995;13:604–607.
Fontana JA. Radiation recall associated with VP-16–213 therapy. Cancer Treat Rep 1979;63:224–225.
von Essen CF, Kligerman MM, Calabresi P. Radiation and 5-fluorouracil: A controlled clinical study. Radiology 1963;81:1018–1026.
Sroa N, Bartholomew DA, Magro CM. Lipodermatosclerosis as a form of vascular compromise-associated radiation recall dermatitis: case report and a review of literature. J Cutan Pathol 2006;33(suppl 2):55–59.
Bar-Sela G, Beny A, Bergman R et al. Gemcitabine-induced radiation recall dermatitis: case report. Tumori 2001;87:428–430.
Jeter MD, Janne PA, Brooks S et al. Gemcitabine-induced radiation recall. Int J Radiat Oncol Biol Phys 2002;53:394–400.
Schwarte S, Wagner K, Karstens JH et al. Radiation recall pneumonitis induced by gemcitabine. Strahlenther Onkol 2007;183:215–217.
Castellano D, Hitt R, Ciruelos E et al. Biweekly vinorelbine and gemcitabine: a phase I dose-finding study in patients with advanced solid tumors. Ann Oncol 2003;14:783–787.
Burstein HJ. Side effects of chemotherapy. Case 1. Radiation recall dermatitis from gemcitabine. J Clin Oncol 2000;18:693–694.
Sears ME. Erythema in areas of previous irradiation in patients treated with hydroxyurea (NSC-32065). Cancer Chemother Rep 1964;40:31–32.
Gabel C, Eifel PJ, Tornos C et al. Radiation recall reaction to idarubicin resulting in vaginal necrosis. Gynecol Oncol 1995;57:266–269.
Thomas R, Stea B. Radiation recall dermatitis from high-dose interferon alfa-2b. J Clin Oncol 2002;20:355–357.
Kellie SJ, Plowman PN, Malpas JS. Radiation recall and radiosensitization with alkylating agents. Lancet 1987;1:1149–1150.
Kharfan Dabaja MA, Morgensztern D, Markoe AM et al. Radiation recall dermatitis induced by methotrexate in a patient with Hodgkin’s disease. Am J Clin Oncol 2000;23:531–533.
Chan RT, Au GK, Ho JW et al. Radiation recall with oxaliplatin: report of a case and a review of the literature. Clin Oncol (R Coll Radiol) 2001;13: 55–57.
Kundak I, Oztop I, Soyturk M et al. Paclitaxel-carboplatin induced radiation recall colitis. Tumori 2004;90:256–258.
Bostro¨m A, Sjolin-Forsberg G, Wilking N et al. Radiation recall–another call with tamoxifen. Acta Oncol 1999;38:955–959.
Lampkin BC. Skin reaction to vinblastine. Lancet 1969;1:891.
