Paclitaxel-Carboplatin Induced Radiation Recall Colitis

Abstract

Some chemotherapeutic agents can "recall" the irradiated volumes by skin or pulmonary reactions in cancer patients who previously received radiation therapy. We report a recall colitis following the administration of paclitaxel-containing regimen in a patient who had been irradiated for a carcinoma of the uterine cervix. A 63-year-old woman underwent a Wertheim operation because of uterine cervix carcinoma. After 8 years of follow-up, a local recurrence was observed and she received curative external radiotherapy (45 Gy) to the pelvis. No significant adverse events were observed during the radiotherapy. Approximately one year later, she was hospitalized because of metastatic disease with multiple pulmonary nodules, and a chemotherapy regimen consisting of paclitaxel and carboplatin was administered. The day after the administration of chemotherapy the patient had diarrhea and rectal bleeding. Histological examination of the biopsy taken from rectal hyperemic lesions showed a radiation colitis. The symptoms reappeared after the administration of each course of chemotherapy and continued until the death of the patient despite the interruption of the chemotherapy. In conclusion, the probability of recall phenomena should be kept in mind in patients who received previously with pelvic radiotherapy and treated later with cytotoxic chemotherapy.

Radiation recall phenomenon presenting as myositis triggered by carboplatin plus paclitaxel and related literature review

“…There have been several published cases of radiation recall dermatitis induced by paclitaxel, [23][24][25][26] and another report of paclitaxel and carboplatin-caused radiation recall colitis. [27] In that case, colitis-related symptoms started the day after administration of chemotherapy. In our case, the time interval between the end of radiotherapy and the beginning of chemotherapy was approximately 1 month, whereas radiation recall myositis developed 4 months after chemotherapy, which was not a significantly different trend from previous reports.…”

Grade 3 Radiation Recall Sigmoiditis after Treatment for Locally Advanced Cervical Cancer: A Case Report

“…Kundak, et al published the case of a 63-year-old woman, previously irradiated for cervical cancer, who developed radiation colitis following the administration of paclitaxel and carboplatin for multiple lung metastases. She presented with diarrhea and rectal bleeding after the administration of each course of chemotherapy and was treated with supportive care every time [ 3 ].…”

An Ambiguous Phenomenon of Radiation and Drugs: Recall Reactions

“…However, the immediate onset of the reaction, the absence of the reaction in some cases that were rechallenged with the same drug, and the nonexistence of atrophy on the skin after the recovery of the lesion do not support these hypotheses. [23,36,37] dermatitis, pneumonitis, esophagitis Bleomycin [19] dermatitis Capecitabine [38,39] dermatitis, gastritis Cyclophosphamide [29] dermatitis, panniculitis, and myositis Cytarabine [40] supraglottitis Dacarbazine [41] dermatitis Docetaxel [18,42,55] dermatitis, mucositis Etoposide [20] dermatitis 5-Fluorouracil [43] dermatitis Gemcitabine [2,4,34,44] dermatitis, myositis, colitis, optic neuritis, brainstem radionecrosis, lymphangitis, pericardial effusion, and tamponade Hydroxyurea [5] erythema Idarubicin [45] vaginal necrosis Interferon alpha 2B [46] dermatitis Methotrexate [47] dermatitis Oxaliplatin [48] dermatitis Paclitaxel [33,49,50] colitis, dermatitis, and pneumonitis Simvastatin [15] dermatitis Tamoxifen [51] dermatitis Trimetrexate [52] dermatitis Tuberculosis medication dermatitis (isoniazid, rifampicin, pyrazinamide) [53] Vinblastine [54] dermatitis…”

“…Similarly, histopathological findings are also nonspecific for internal organs. Kundak et al [33] reported that histological examination of the biopsy material taken from rectum revealed microabscesses and severe inflammation of the mucosa and the lamina propria, which were suggestive of radiation colitis. In the case that was reported by Vogl et al [34], a tissue sample from the pericardial window showed fibrin mixed with rare inflammatory cells and no evidence of malignancy, and pericardial fluid showed only reactive mesothelial cells and mixed lymphocytes.…”