Table 1.
Collection of previous case reports of gemcitabine-induced radiation recall myositis
| Author | Cancer type | Radiation location | Dose | CTx regimen | Time between RT and gemcitabine start | Time between RT completion and recall symptoms | Clinical symptoms/signs | Under-going chemo at time of symptom onset? | Imaging findings (and modality) | Treatment | Outcome | Post-treatment CTx? |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Alco et al. [19] | Pancreatic adeno carcinoma | Pancreas and regional lymph nodes | 1.8 Gy × 25 (45 Gy) | Gemcitabine 1,250 mg/m2/week, 3 weeks in 4 week cycle | 0 (concurrent) | 20 weeks | Tender mass, pain, and swelling of abdominal muscles | No (last dose 1 month before onset) | Edema and inflammation of the anterior and right abdominal wall muscles (MRI) | Corticosteroids, NSAIDs, and gabapentin | Symptom reduction in 1 week; clinical and radiologic findings resolved in 1 month | N/A |
| Alco et al. [19] | NSCLC | Left upper lobe and ipsilateral L2 lymph nodes | 62 Gy total (fractions N/A) | Gemcitabine (1,200 m/m2 for 1–8 days), and carboplatin (AUC 5.5 for days 1 and 30), for 3 cycles; gemcitabine reduced to 800 mg/m2 after first cycle because of intolerance | N/A (CTx started after RT) | N/A (∼104 days after starting CTx) | Pain and swelling of left breast and chest wall, with reduced ROM of arm and shoulder | No (last dose 2 weeks before onset) | Edema and soft tissue reaction at the left breast musculature and subcutaneous soft tissue (MRI) | Corticosteroids, NSAIDs, opioids, antihistamines, SOD, pentoxifylline, vitamin E, gabapentin, topical lidocaine and selenium | Meds did not affect myositis; pain reduced after 4 months, resolved after 9 months, with lasting reduced ROM | N/A |
| Delavan et al. [15] | Breast cancer | Left thigh | 8 Gy × 1 (8 Gy) (4 years prior) 3 Gy × 13 (39 Gy) (4 months prior) |
Gemcitabine (unknown dosage) | 17 days | 107 days | Increasing pain and swelling to the posterior left thigh, warm to palpation | No (last dose ∼3.5 weeks before onset) | Increased signal intensity in the posterior thigh musculature (MRI) | Dexamethasone | Symptoms improved over 3 days, symptom free 1 week later | Not reported |
| Eckardt et al. [17] | Synovial sarcoma | Right forearm | 3.5 Gy × 8 (28 Gy) preop, followed by 2 Gy × 10 (20 Gy) boost | Gemcitabine (900 mg/m2 on days 1 and 8) and docetaxel (100 mg/m2 on day 8) for 2 cycles at 21 and 28 days, respectively | 5 days | 40 days | Swelling of the right forearm with progressively worsening range of motion, compartment syndrome | No (last dose 7 days before onset) | Edema of the flexor compartment muscles, with layering fluid along the superficial fascia and between the muscles (MRI) | Dexamethasone | Patient required slow taper corticosteroids for multiple months; patient continues to have muscle edema and myositis on 1-year follow-up MRI. | No |
| Fakih [20] | Pancreatic adenocarcinoma | Pancreas | 1.8 Gy × 28 (50.4 Gy) | Concurrent fluorouracil (2,000 mg/m2/day for 5 days a week) and gemcitabine (200 mg/m2 weekly) followed by adjuvant gemcitabine (1,000 mg/m2/week for 3 weeks every 4-week cycle) | 0 days (concurrent) ∼21 days to initiation of adjuvant dose gemcitabine |
∼18 weeks | Erythematosus rash overlying a tender mass in the epigastrium | Yes | Enlarged left and right rectus abdominus with areas of heterogeneity (CT) | None, other than withholding gemcitabine | Complete resolution | Yes (capecitabine, docetaxel, and cisplatin) |
| Fogarty et al. [21] | NSCLC | Lung | 3 Gy × 12 (36 Gy) | Gemcitabine (1,000 mg/m2 on days 1 and 8) and carboplatin (AUC 5, day 1) | ∼3 months | ∼4.5 months | Posterior chest wall pain with localized tenderness, skin rash, elevated CK, ESR | Yes | Enhancement of the chest wall musculature consistent with nonspecific inflammatory change (MRI) | NSAIDS, oral steroids | Symptoms improved but persistent minor skin changes and subcutaneous fibrosis | Not reported |