Report of a unique case of gemcitabine-induced radiation recall myelitis following spinal cord irradiation

• Published in: BJR case reports Vol. 6; no. 3; p. 20190118
• Main Authors: Masson, Ingrid, Supiot, Stéphane, Doutriaux-Dumoulin, Isabelle, Thillays, François
• Format: Journal Article
• Language: English
• Published: The British Institute of Radiology 01.09.2020
• Subjects: Case Report
• ISSN: 2055-7159; 2055-7159
• DOI: 10.1259/bjrcr.20190118

Radiation recall is a rare phenomenon, defined as an acute inflammatory reaction in a previously irradiated area, after administration of anti-tumor agents, including chemotherapy. It is most commonly reported to trigger skin reactions but internal organ involvement is possible, particularly with gemcitabine. We report here a unique case of a gemcitabine-induced radiation recall myelitis following spinal irradiation. A 53-year-old patient received analgesic irradiation of the seventh thoracic vertebra (T7) in the context of metastatic non-small cell lung cancer, at conventional radiotherapy dose and fractionation. She was subsequently treated with gemcitabine and developed myelitis whose chronology is compatible with a radiation recall reaction. Spinal MRI confirmed a T6–T7 spinal cord enhancement, with an associated spinal cord oedema. Corticosteroids and supportive care did not improve myelitis symptoms. The patient died within a year of the radiation recall, due to a metastatic progression of lung cancer. This is, to our knowledge, the first reported case of gemcitabine-induced radiation recall myelitis and only the third case involving the spinal cord. Radiation recall is a rare and poorly understood phenomenon and all cases should be reported.