title: Radiation recall dermatitis induced by sorafenib : A case study and review of the literature.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.|Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, 5232, Villigen, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Stieb
authors.affiliation: Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Riesterer
authors.affiliation: Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Brüssow
authors.affiliation: Department of Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Pestalozzi
authors.affiliation: Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Guckenberger
authors.affiliation: Department of Clinical Pharmacology and Toxicology, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. stefan.weiler@usz.ch.
authors.forename: Stefan
authors.initials: S
authors.lastname: Weiler
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001859:Bone Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000556:secondary*; D006801:Humans; D008297:Male; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011855:Radiodermatitis / Q000139:chemically induced* / Q000517:prevention & control*; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D000077157:Sorafenib; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D000077157:Sorafenib
keywords: Chemotherapy; Erythema; Hepatocellular carcinoma; Radiotherapy; Toxicity