Radiation recall dermatitis and pneumonitis in a patient treated with paclitaxel.

BACKGROUND: Radiation recall refers to a tissue reaction produced by a chemotherapeutic agent in a previously irradiated field that would not occur in a nonirradiated field. A number of agents have been reported to cause radiation recall. Recently, there have been case reports of recall dermatitis from paclitaxel treatment. METHODS: A patient with metastatic lung cancer received palliative radiation to her mediastinum and ribs. Because of disease progression, she subsequently received paclitaxel. RESULTS: After paclitaxel administration, the patient became acutely dyspneic. A subsequent chest X-ray revealed a parenchymal opacity in a region that corresponded with the patient's radiation portal. She also developed a severe skin reaction in the previously treated electron field. CONCLUSIONS: This is one of few reported cases of recall dermatitis from paclitaxel and is also suggestive of recall pneumonitis, a phenomenon previously unreported to the authors' knowledge. Given paclitaxel's ability to function as a radiosensitizer, this response is not unexpected. As the frequency of paclitaxel administration increases, its potential as a radiation sensitizer and radiation recall should be considered.

Radiosurgery of cavernous sinus tumors.

Stereotactic radiosurgery was applied to concentrate high dose of photon irradiation to tumors enclosed in the cavernous sinus. We have treated 10 meningiomas, five pituitary tumors, and three metastatic lesions in the past two years. Follow-up time ranges from 3 to 18 months with an average of 10 months. Tumor volume ranged from 0.92 to 53.31 cc with an average 10.79 cc. CT scans and MRIs were used to demonstrate the tumor relationship to cranial nerves and structures of the brain. One to 6 isocenters were used. Collimator size varied from 7 to 28 mm, and the dose to the margin of the tumor ranged from 1400 to 2500 cGy with an average of 1650 cGy. Maximal dose range of 1575 to 5000 cGy. The margin of the tumor was encompassed within the 50 to 95% isodose volume with an average treatment prescribed to the 57% isodose volume. Symptomatic response was seen in 12 patients, and stabilization of symptoms in three patients with progression of symptoms observed in three patients. Radiographic imaging revealed response in eight patients, unchanged in three patients and progression in three patients. This report shows the feasibility of applying linear accelerator radiosurgery to the treatment of cavernous sinus tumors. This form of therapy promises to play an important role in complementing tumor resection.

Comparison between radiosurgery and stereotactic fractionated radiation for the treatment of brain metastases.

This study evaluates the treatment of intracerebral brain metastases with single dose stereotactic radiosurgery in comparison to stereotactic fractionated radiotherapy (SFR). Twenty six patients with 41 lesions were evaluated. Thirty four lesions in 19 patients were treated with radiosurgery, and 7 lesions in 7 patients were treated with SFR. The radiosurgery group was treated with an average number of isocenters of 1.4, and an average of 9 arcs. The average dose was 2140 cGy delivered to the 70% isodose line. The average volume of the lesions was 5.22 cc. The SFR group lesions received a mean dose to the indicated area delivered by 4 to 6 coplanar fields. The dose was 600 cGy per fraction, 2 to 3 fractions were given. The average volume of the treated lesions was 21.2 cc. Follow-up extended from 2-18 months. Twenty five lesions of the radiosurgery group had image follow-up. The overall local control was seen in 92% of the patients. Six lesions of the SFR group had image follow-up, the local control was 83%. The small number in each group, the non-randomized nature of the study, and the relatively short follow-up preclude a definitive conclusion. SFR may be the method of choice for large lesions surrounded by significant edema. The delivery of the dose in large fractions may obviate the transient acute reactions seen when radiosurgical dose is delivered to large lesions surrounded by edema. However, both forms of therapy have proven to be effective in the control of brain metastases.