Table 2.

Collection of previous case reports of gemcitabine-induced radiation recall myositis (continued)

Author	Cancer type	Radiation location	Dose	CTx regimen	Time between RT and gemcitabine start	Time between RT completion and recall symptoms	Clinical symptoms/signs	Undergoing chemo at time of symptom onset?	Imaging findings (and modality)	Treatment	Outcome	Post-treatment CTx?
Friedlander et al. [7]	Pancreatic adenocarcinoma	Pancreas and regional lymph nodes	1.8 Gy × 28 (50.4 Gy)	Gemcitabine (40 mg/m2 biweekly and concurrently with radiation, followed by 1,000 mg/m2 weekly for 3 weeks per month)	39 days	3 months	Tenderness of rectus muscles, mild rash, elevated CK	Yes	Increased signal in the subcutaneous tissue of the anterior abdominal wall (MRI)	Corticosteroids	Complete resolution, no recurrence after steroid tapering	Not reported
Ganem et al. [22]	Squamous cell carcinoma of the lung	Pelvis	3 Gy × 11 (33 Gy)	Gemcitabine (1,000 mg/m2 on days 1, 8, 15) and cisplatin (100 mg/m2 on day 15)	1.5 months	5 months	Right buttock pain	Yes	Hypersignal and edema on gluteal soft tissue (MRI)	Oral opiates, antibiotics, steroids	Alleviation over the course of 3 months	Not reported
Graf et al. [16]	NSCLC and anal cancer, history of dermatomyositis	Pelvis	Not reported	5-FU and MMC given with pelvic RT for anal cancer, carboplatin and gemcitabine (dosage not given)	2 months	4 months	Erythema, swelling, warmth, and tenderness of the buttocks and groin area	Yes	High signal in the bilateral gluteal maximus, quadratus femoris, adductor magnus, obturator externus and right iliopsoas muscles (MRI), elevated CK	Prednisone and opiate analgesia	Gradual improvement with steroids	Not reported
Grover et al. [5]	Adenocarcinoma and neuroendocrine neoplasm, unknown primary	Left hip and left acromion	3 Gy × 10 (30 Gy)	Gemcitabine (1,250 mg/m2) and carboplatin (AUC 5)	2 weeks	4 weeks	Worsening pain in left shoulder and hip	Yes	Soft tissue edema of the muscles adjacent to the left acromion and the left hip (MRI)	Narcotics	Pain resolved 5 months after radiotherapy	Gemcitabine therapy continued
Horan et al. [23]	NSCLC	Lung	3 Gy × 8 (24 Gy)	Gemcitabine (1,000 mg/m2, weekly)	2 months	∼13 weeks	Pain and swelling of the right pectoralis major, biopsy proven muscle necrosis	Yes	Thickening of right pectoralis major muscle (CT)	Analgesics	Symptoms gradually declined when gemcitabine was stopped	Gemcitabine re-challenge, no further symptoms
Jeter et al. [11]	Pancreatic adenocarcinoma	Pancreas	1.8 Gy × 28 (50.4 Gy)	Gemcitabine (1,000 mg/m2 one dose; followed by 750 mg/m2 weekly for 9 months)	3 weeks	3 months	Abdominal wall tenderness and erythema	Yes	Subcutaneous fat stranding and decreased density of rectus muscles in radiation portal (CT)	Ibuprofen	Symptoms responsive to ibuprofen	Gemcitabine re-challenge, no further symptoms
Lock et al. [24]	Hepatic adenocarcinoma	Liver	2.94 Gy × 15 (44.1 Gy)	Gemcitabine (1,000 mg/m2 for days 1 and 8 for a 3-week cycle)	8 weeks	18 weeks	Abdominal discomfort with induration; overlying skin erythema	Yes	Enhancement of abdominal muscles with thickening (MRI)	Ibuprofen, vitamin E, and vitamin C	Gradual resolution over the course of 6 weeks	Gemcitabine was continued, reduction of symptoms
Miura et al. [25]a	NSCLC	Right hip	2 Gy × 25 (50 Gy)	Concurrent cisplatin (80 mg/m2 day 1) and vinorelbine (20 mg/m2, days 1, 8, and 15) followed by gemcitabine (800 mg/m2 biweekly)	1 month	3 months	Right thigh pain	N/A	Edema within right thigh muscles (MRI)	Analgesics	Gradual resolution of symptoms	Yes (unknown regimen)