Strahlentherapie und Onkologie

, Volume 192, Issue 5, pp 342–348 | Cite as

Radiation recall dermatitis induced by sorafenib

A case study and review of the literature
  • Sonja Stieb
  • Oliver Riesterer
  • Cornelia Brüssow
  • Bernhard Pestalozzi
  • Matthias Guckenberger
  • Stefan Weiler
Case Study

Abstract

Background

Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin, mainly subsequent to the administration of certain chemotherapeutics. Here we present a rare case of RRD induced by the oral multikinase inhibitor sorafenib.

Case report

A 77-year-old male with hepatocellular carcinoma was irradiated at ten different sites for bone metastases with 20–36 Gray in 5–12 fractions from January to March 2015. Sorafenib 400 mg was administered twice daily from mid-March. One week later the patient presented with fever and erythematous lesions on the right upper arm, mandible, and trunk. All skin symptoms were confined to previously irradiated areas. After RRD was diagnosed by exclusion of other causes and skin biopsy, sorafenib was paused. With the administration of topical corticosteroids and oral antihistamines, the skin reaction subsided within several days. Sorafenib was readministered after 3 weeks, which did not lead to recurrence of RRD but did cause fluctuating fever.

Discussion

Only four other such cases have been reported in the literature and WHO pharmacovigilance database on individual case safety reports. The current report is the first to show a potential relationship between the severity of sorafenib-induced RRD and radiation dose, histopathological features, and simultaneous acute radiation dermatitis and mucositis.

Conclusion

RRD induced by sorafenib is a rare phenomenon, but should be considered in patients showing erythematous skin lesions 1–2 weeks after initiation of the drug, predominantly in areas where skin has been irradiated with an equivalent dose ≥ 30 Gy. Discontinuation of sorafenib with possible readministration should be evaluated with respect to the clinical situation and severity of reaction.

Keywords

Hepatocellular carcinoma Radiotherapy Chemotherapy Toxicity Erythema 

Recall-Strahlendermatitis durch Sorafenib

Eine Fallstudie und Literaturübersicht

Zusammenfassung

Hintergrund

Recall-Strahlendermatitis (RRD) ist eine akute Entzündungsreaktion der Haut in zuvor bestrahlten Arealen, welche meist nach Einnahme bestimmter Chemotherapeutika auftritt. Nachfolgend präsentieren wir einen seltenen Fall von RRD unter Therapie mit dem Multikinaseinhibitor Sorafenib.

Fallbeschreibung

Ein 77-jähriger, männlicher Patient mit ossär metastasiertem hepatozellulärem Karzinom wurde zwischen Januar und März 2015 an insgesamt 10 verschiedenen Lokalisationen mit 20–36 Gy in 5–12 Fraktionen bestrahlt. Ab Mitte März wurde 400 mg Sorafenib 2-mal täglich verabreicht. Eine Woche später entwickelte der Patient Fieber und erythematöse Hautläsionen am rechten Oberarm, Unterkiefer und Rumpf. Die Hautveränderungen waren allesamt auf zuvor bestrahlte Areale begrenzt. Nach Ausschluss anderer Ursachen mittels Biopsie einer der Hautveränderungen wurde die klinische Diagnose einer RRD gestellt. Sorafenib wurde pausiert und topische Kortikosteroide sowie orale Antihistaminika verabreicht, woraufhin die Hautreaktionen abklangen. Eine erneute Gabe von Sorafenib nach insgesamt 3-wöchiger Pause führte zu keiner neuerlichen Hautreaktion, löste jedoch fluktuierendes Fieber aus.

Diskussion

Weltweit wurden bislang nur vier weitere Fälle von RRD unter Sorafenib berichtet. Im vorliegenden Fall werden erstmals ein potentieller Zusammenhang des Schweregrads der RRD unter Sorafenib mit der Bestrahlungsdosis der Haut, die histopathologischen Veränderungen sowie eine gleichzeitig vorliegende akute Strahlendermatitis und Mukositis dargestellt.

Schlussfolgerung

Durch Sorafenib hervorgerufene RRD ist ein seltenes Phänomen, das in den bestrahlten Hautarealen, vornehmlich nach einer Äquivalentdosis von ≥ 30 Gy, als erythematöse Hautreaktion 1–2 Wochen nach Therapiebeginn mit der Substanz auftritt. Eine Therapiepause mit möglichem Wiederbeginn von Sorafenib sollte abhängig von der klinischen Situation und dem Schweregrad der Reaktion evaluiert werden.

Schlüsselwörter

Hepatozelluläres Karzinom Strahlentherapie Chemotherapie Toxizität Erythem 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sonja Stieb
    • 1
    • 2
  • Oliver Riesterer
    • 1
  • Cornelia Brüssow
    • 1
  • Bernhard Pestalozzi
    • 3
  • Matthias Guckenberger
    • 1
  • Stefan Weiler
    • 4
  1. 1.Department of Radiation OncologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Center for Proton TherapyPaul Scherrer Institute, Villigen PSIVilligenSwitzerland
  3. 3.Department of OncologyUniversity Hospital ZurichZurichSwitzerland
  4. 4.Department of Clinical Pharmacology and ToxicologyUniversity Hospital and University of ZurichZurichSwitzerland

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