Learning objectives
To present a case of gemcitabine-induced radiation recall (GIRR) myositis of the left sartorius muscle, with discussion of the topic and review of imaging. GIRR myositis is a rare condition and an unusual cause of focal muscle injury induced by a sytemic therapy, with little documentation within radiology literature.
Background
Radiation recall is an acute non-immune inflammatory reaction within a previous radiotherapy field, triggered by subsequent administration of cytotoxic medications or other agents. Gemcitabine-induced radiation recall myositis is one type of reaction which is an unusual cause of focal muscle injury from a systemic agent. Although recognised by oncologists, there are few reports in the imaging literature, and diagnosis by radiologists may be further limited without knowledge of the complete therapeutic timeline.
Imaging findings OR Procedure details
A 74-year-old female presented with one day history of left hip pain, thigh swelling, leg weakness and inability to weight bear. Examination showed left lower limb swelling, pitting oedema below the knee and firm enlargement of anterior thigh. She had recently commenced chemotherapy six weeks prior with gemcitabine for oligometastatic squamous cell lung carcinoma. Three months before her presentation, she received palliative radiation at a dose of 20 Gray in 5 fractions to a symptomatic 2.2 cm biopsy-proven lytic metastasis in the left acetabulum. The...
Conclusion
Radiation recall is an uncommon, unpredictable condition characterised by an acute inflammatory reaction in previously irradiated areas precipitated by a systemic agent [1, 2]. The time interval between prior radiotherapy and onset of radiation recall ranges from weeks to years [1, 2]. Chemotherapeutic agents are the most common trigger, with doxorubicin, gemcitabine, and docetaxel the most frequently documented [1, 2]. Other drugs have also been implicated including some antibiotics and simvastatin [1, 2]. The condition improves or resolves with withdrawal of the culprit, and in...
References
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McKay MJ, Foster R. Radiation recall reactions: An oncologic enigma. Critical reviews in oncology/hematology. 2021 Dec 1;168:103527.
Ravishankar A, Park SS, Olivier KR, Corbin KS. Gemcitabine-induced Radiation Recall Myositis: Case Report and Review of the Literature. Case Rep Oncol 2018; 11: 168-178.
Delavan JA, Chino JP, Vinson EN. Gemcitabine-induced Radiation Recall Myositis. Review. Skeletal Radiol 2015; 44(3): 451-455.
Friedlander PA, Bansal R, Schwartz L, Wagman R, Posner J, Kemeny N. Gemcitabine‐related...