American Journal of Clinical Dermatology

, Volume 1, Issue 2, pp 113–116 | Cite as

Radiation-Recall Skin Disorders Associated With the Use of Antineoplastic Drugs

Pathogenesis, Prevalence, and Management
  • Winnie Yeo
  • Philip J. Johnson
Review Article


Radiation-recall dermatitis is the occurrence, with subsequent administration of cytotoxic chemotherapy, of an acute inflammatory toxicity in a previously quiescent radiation field. It may occur from days to weeks, and sometimes years, after the radiation therapy. The precise mechanism is unknown. One hypothesis suggests that the initial radiation therapy leads to a depletion of tissue stem cells within the irradiated field and that subsequent cytotoxic chemotherapy exposure causes a ‘remembered’ reaction among the remaining surviving cells. An alternative proposition suggests that radiation induces heritable mutations within surviving cells, which then produce a subgroup of defective stem cells that are unable to tolerate the second insult of chemotherapy. Recently, ataxia telangiectasia gene mutation and protein kinase deficiency have been associated with patients who have increased susceptibility to severe radiation-induced skin toxicity.

Most of the lesions will heal with supportive treatment. Although some reports have noted that radiation-recall dermatitis recurred with subsequent continued administration of the same chemotherapeutic agent, such experience is not universal. At present, a decision as to whether the same chemotherapeutic agent can be continued will usually be determined by the severity of the initial reaction, the chemoresponsiveness of the tumor to this particular agent, the individual patient’s wishes, and a clinical judgment that takes into account the availability of alternative therapy.


Docetaxel Ataxia Telangiectasia Ataxia Telangiectasia Skin Dose Dactinomycin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Eifel P.J., McClure S. Severe chemotherapy-induced recall of radiation mucositis in a patient with non-Hodgkin’s lymphoma of Waldeyer’s ring [letter]. Int J Radiat Oncol Biol Phys 1989; 17: 907–908PubMedCrossRefGoogle Scholar
  2. 2.
    Mcinerney D.P., Bullimore J. Reactivation of radiation pneumonitis by adriamycin.Br J Radiol 1977; 50: 224–227CrossRefGoogle Scholar
  3. 3.
    Cassady J.R., Richter M.T., Piro A.J., et al. Radiation-adriamycin interactions: preliminary clinical observations. Cancer 1975; 36: 946–949PubMedCrossRefGoogle Scholar
  4. 4.
    Kellie S.J., Plowman P.N., Malpas J.S. Radiation recall and radiosensitization with alkylating agents. Lancet 1987; I (8542): 1149–1150CrossRefGoogle Scholar
  5. 5.
    Donaldson S.S., Glick J.M., Wilbur J.R. Adriamycin activating a recall phenomenon after radiation therapy. Ann Intern Med 1974; 81: 407–408PubMedGoogle Scholar
  6. 6.
    Redpath J.L., Cloman M. The effect of adriamycin and actinomycin D on radiation-induced skin reactions in mouse feet. Int J Radiat Oncol Biol Phys 1979; 5: 483–486PubMedCrossRefGoogle Scholar
  7. 7.
    D’Angio G.J., Farber S., Maddock C.L. Potentiation of X-ray effects by actinomycin D. Radiology 1959; 73: 175–177PubMedGoogle Scholar
  8. 8.
    Pui C.H., de Graaf S.S.N., Dow L.W., et al. Phase 1 clinical trial of orally administered 4-demethoxydaunorubicin (idarubicin) with pharmacokinetic and in vitro drug sensitivity testing in children with refractory leukemia. Cancer Res 1998; 48: 5348–5352Google Scholar
  9. 9.
    Steizer K.J., Griffin T.W., Koh W.J. Radiation recall skin toxicity with bleomycin in a patient with Kaposi sarcoma related to acquired immune deficiency syndrome.Cancer 1993; 71: 1322–1325CrossRefGoogle Scholar
  10. 10.
    Von Essen C.F., Kilgerman M.M. Calbresi P. Radiation and 5-fluorouracil: a controlled clinical study. Radiology 1963; 81: 1018–1027Google Scholar
  11. 11.
    Nemechek P.M., Corder M.C. Radiation recall associated with vinblastine in a patient treated for Kaposi sarcoma related with Acquired Immune Deficiency Syndrome. Cancer 1992; 70: 1605–1606PubMedCrossRefGoogle Scholar
  12. 12.
    Sears M.E. Erythema in areas of previous irradiation in patients treated with hydroxyurea (NSC-32065). Cancer Chemother Rep 1964; 40: 31–32PubMedGoogle Scholar
  13. 13.
    Jolivet J., Landry L., Pinard M.F., et al. A Phase 1 study of trimetrexate, an analog of methotrexate, administered monthly in the form of nine consecutive daily bolus injections. Cancer Chemother Pharmacol 1987; 20: 169–172PubMedCrossRefGoogle Scholar
  14. 14.
    Fontana J.A. Radiation recall associated with VP-16-213 therapy. Cancer Treat Rep 1979; 63: 224–225PubMedGoogle Scholar
  15. 15.
    Phillips K.A., Urch M., Bishop J.F. Radiation-recall dermatitis in a patient treated with paclitaxel. J Clin Oncol 1995; 13: 305PubMedGoogle Scholar
  16. 16.
    Shenkier T., Gelmon K. Paclitaxel and radiation-recall dermatitis. J Clin Oncol1994; 12: 439Google Scholar
  17. 17.
    Yeo W., Leung S.F., Johnson P.J. Radiation-recall dermatitis with docetaxel: establishment of a requisite radiation threshold. Eur J Cancer 1997; 33 (4): 698–699PubMedCrossRefGoogle Scholar
  18. 18.
    Philips T.L., Fu K.K. Quantification of combined radiation therapy and chemotherapy affects on critical normal tissues. Cancer 1976; 37: 1186–1200CrossRefGoogle Scholar
  19. 19.
    Fu K.K. Normal tissue effects of combined radiotherapy and chemotherapy for head and neck cancer. Front Radiat Ther Oncol 1979; 13: 113–132Google Scholar
  20. 20.
    Cantril S.T. Audience interaction. Front Radiat Ther Oncol 1979; 13: 145–146Google Scholar
  21. 21.
    Danjoux C.E. Delayed complications following combination of radiation and chemotherapy.Int J Radiat Oncol Biol Phys 1979; 5: 441–443PubMedCrossRefGoogle Scholar
  22. 22.
    Philips T.L., Wharam M.D., Margolis L.W. Modification of radiation injury to normal tissues by chemotherapeutic agents. Cancer 1975; 34: 1678–1684CrossRefGoogle Scholar
  23. 23.
    Busch D. Genetic susceptibility to radiation and chemotherapy injury: diagnosis and management. Int J Radiat Oncol Biol Phys 1994; 30: 997–1002PubMedCrossRefGoogle Scholar
  24. 24.
    West C.M., Elyan S.A., Berry P., et al. A comparison of the radiosensitivity of lymphocytes from normal donors, cancer patients and individuals with ataxiatelangiectasia (A-T) and A-T heterozygotes. Int J Radiat Oncol Biol Phys 1995; 68: 197–203Google Scholar
  25. 25.
    Jongmans W., Artuso M., Vuillaume M., et al. The role of ataxia-telangiectasia and the DNA-dependent protein kinase in the p53-mediated cellular response to ionizing radiation. Oncogene 1996; 13: 1133–1138PubMedGoogle Scholar
  26. 26.
    Opptiz U., Bernthaler U., Schindler D., et al. Sequence analysis of the ATM gene in 20 patients with RTOG grade 3 or 4 acute and/or late tissue radiation side effects. Int J Radiat Oncol Biol Phys 1999: 44: 981–988CrossRefGoogle Scholar
  27. 27.
    Tan C.T.C., Dargeon H.W., Burchenal J.H. The effect of actinomycin D on cancer in childhood. Pediatric 1959; 24: 544–561Google Scholar
  28. 28.
    Seymour C.B., Mothersill Q., Alper T. High yields of lethal mutations in somatic mammalian cells that survive ionizing radiation. Int J Radiat Biol 1986; 50: 167–179CrossRefGoogle Scholar
  29. 29.
    Hellman S., Botnick L.E. Skin cell depletion. an explanation of the late effects of cytotoxins. Int J Radiat Oncol Biol Phys 1977; 2: 181–184PubMedCrossRefGoogle Scholar
  30. 30.
    Tsichler R.B., Schiff P.B., Geard C.R., et al. Taxol: a novel radiation sensitizer. Int J Radiat Oncol Biol Phys 1992; 22: 613–617CrossRefGoogle Scholar
  31. 31.
    Kitani H., Kosaka T., FukMara T., et al. The ‘recall effect’ in radiotherapy: is subeffective, reparable damage responsible? Int J Radiat Oncol Biol Phys 1990; 18: 689–695PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Winnie Yeo
    • 1
  • Philip J. Johnson
    • 1
  1. 1.Department of Clinical OncologyChinese University of Hong Kong, Prince of Wales HospitalShatin, New TerritoriesHong Kong

Personalised recommendations