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A Child With Gemcitabine-induced Severe Radiation Recall Myositis Resulting in a Compartment Syndrome

Eckardt, Mark A. BA; Bean, Adrienne MD; Selch, Michael T. MD; Federman, Noah MD

Journal of Pediatric Hematology/Oncology:
doi: 10.1097/MPH.0b013e31827e4c28
Clinical and Laboratory Observations
Abstract

Chemotherapeutic induction of radiation recall (RR) is a rare event in which a chemotherapeutic agent given days to years after radiation therapy causes an inflammation reaction of the tissues within the irradiated area—“recalling” increased radiation effects to that area. In this unique case, a 14-year-old girl with a synovial sarcoma of the forearm was treated with neoadjuvant chemotherapy and radiation therapy. Gemcitabine was administered in an adjuvant setting inducing a RR reaction. The severity of the inflammation resulted in a forearm myositis secondarily causing a compartment syndrome that was treated with several prolonged courses of corticosteroids. The symptoms of RR and compartment syndrome have resolved 1 year postonset, although magnetic resonance imaging continues to show myositis and soft-tissue edema. This case highlights the need to maintain a heightened awareness to recognizing the signs and symptoms of RR and the potential severity of RR in pediatric cancer patients in conjunction with chemotherapeutic agents used more frequently in adults.

Author Information

Departments of *Medicine, Division of Hematology/Oncology

Diagnostic Radiology

§Radiation Oncology, David Geffen School of Medicine at UCLA

Department of Pediatrics, Division of Hematology/Oncology, Mattel Children’s Hospital at UCLA, David Geffen School of Medicine at UCLA

UCLA’s Jonsson Comprehensive Cancer Center, Los Angeles, CA

N.F. is supported by the St Baldrick’s Foundation Career Development Award and a STOP Cancer Research Award.

The authors declare no conflict of interest.

Reprints: Noah Federman, MD, Department of Pediatrics, Division of Hematology/Oncology, Mattel Children’s Hospital at UCLA, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., MDCC A2-410, Los Angeles, CA 90095 (e-mail: nfederman@mednet.ucla.edu).

Received February 27, 2012

Accepted August 22, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.