Recognizing cisplatin as a potential radiation recall trigger: case report and focused systematic review

Area of Science:

• Oncology
• Dermatology
• Pharmacology

Background:

• Radiation recall dermatitis (RRD) is an inflammatory skin reaction occurring in previously irradiated areas after systemic drug administration.
• Cisplatin, a platinum-based chemotherapy agent, is not widely recognized as a direct trigger for RRD, often being considered a cofactor in multidrug regimens.
• Existing literature often dismisses cisplatin's role, attributing RRD solely to other agents in combination therapies.

Approach:

• A case of mild RRD triggered by concurrent cisplatin chemotherapy and re-irradiation is presented.
• A focused systematic literature review was conducted to reassess cisplatin's potential as a (co-)triggering factor for RRD.
• Analysis included 30 reported cases of RRD, with a focus on the role of cisplatin in multidrug combinations.

Key Points:

• Cisplatin can act as a direct trigger for radiation recall dermatitis.
• Multidrug combinations involving cisplatin were more frequently associated with RRD and tended to cause more severe symptoms.
• No clear correlation was found between radiation dose (above 20 Gy threshold) and the severity or prevalence of RRD.

Conclusions:

• Cisplatin should be recognized as a potential trigger for radiation recall dermatitis.
• Prompt recognition and supportive management of cisplatin-induced RRD can prevent unnecessary chemotherapy cessation.
• Systematic reporting of RRD in clinical trials involving radiation therapy is crucial for advancing understanding of this phenomenon.