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. 2024 Oct;71(10):e31221.
doi: 10.1002/pbc.31221. Epub 2024 Jul 31.

Radiation recall reaction induced by gemcitabine/docetaxel in children: A retrospective study on risk factors and outcomes

Cristina Larrosa  1 , Soraya Mico  2 , Mónica Ramos  2 , Sara Perez-Jaume  3 , Mónica Sánchez  4 , Alicia Castañeda  1 , Moira Garraus  1 , Jaume Mora  1
Affiliations

Radiation recall reaction induced by gemcitabine/docetaxel in children: A retrospective study on risk factors and outcomes

Cristina Larrosa et al. Pediatr Blood Cancer. 2024 Oct.

Abstract

Introduction: Radiation recall reaction (RRR) is a rare inflammatory reaction developing in a previously irradiated field after a triggering agent. In pediatric patients, it is poorly understood and deficiently studied. Gemcitabine-docetaxel (G/D) in childhood cancer is mainly used as a salvage regimen for sarcomas. We aim to describe RRR triggered by G/D in children.

Patients and methods: Retrospective review of 21 patients receiving G/D along with radiotherapy at two hospitals from 2010 until 2022. RRR was considered as any toxicity occurring after G/D administration in a previously irradiated field. RRR features were described. Fisher's and Mann-Whitney tests were utilized to analyze the risk factors involved.

Results: Sixteen episodes of RRR developed in 16 (76.2%) patients. RRR mainly involved deep layers of the skin (58%) and occurred predominantly after two G/D cycles. The mean time between radiotherapy and chemotherapy was 28.5 days (0-1359 days), and the mean radiation volume 391 mL (157-1810 mL) for RRR. RRR treatment was mainly systemic steroids, with partial responses in six of 11 (58%) patients. Re-exposure to G/D was associated with a high rate of recurrence in nine of 15 (56.2%), prompting drug discontinuation. The major risk factors for RRR after G/D include, without statistical significance, a larger volume of the irradiated field and a shorter interval between chemotherapy and radiotherapy.

Conclusions: The incidence of RRR after G/D in the pediatric population is higher than previously reported. Drug re-exposure is usually followed by recurrence. Higher irradiated volumes and a shorter time to the start of chemotherapy could be related with an increased risk of RRR.

Keywords: docetaxel; gemcitabine; radiation; recall.

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References

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