Recall dermatitis caused by reexposition of Docetaxel following irradiation of the brain. Case report and review of literature

Background: Together with radiation therapy the taxanes Paclitaxel and Doce taxel are more and more integrated into multimodal therapy regimens concern ing breast- and Lung cancer as well as squamous cell carcinoma of the head and neck. Especially in palliative situations we have to be aware of increa sing side effects caused by interaction of the different treatment componen ts. Therefore we report on a severe recall dermatitis that occurred in two breast-cancer patients following irradiation of the brain and reexposition to Docetaxel. Patients and Method: From January until March 1999 two female patients suff ering from metastatic breast cancer and newly diagnosed cerebral metastases respectively carcinomatous meningitis underwent irradiation of the whole b rain (2 Gy 5 days/week up to a reference dose of 50 Gy) in our department. Both patients had several courses of Docetaxel. (Taxotere (R)) 30 mg/m(2) B SA weekly respectively 100 mg/m(2) BSA/month since October and November 199 8. After completion of radiotherapy chemotherapy with Docetaxel was continu ed. Results: Both patients tolerated Docetaxel. well before and during radiothe rapy. However, after having finished irradiation of the brain and receiving Docetaxel. again a severe erythema of the irradiated skin and Large areas of moist epitheliolysis with crust occurred (CTC grade IV). Conclusion: The dermatitis related to irradiation and reexposition to Docet axel observed in our two cases is interpreted as a recall reaction. The bas ic initiating pathologic mechanism has not been solved completely. Further investigation is needed to find out how the taxanes can be used in combinat ion radiochemotherapy regimens without causing severe toxicity to the irrad iated skin or mucosa.