A Case of Radiation Recall Myositis and Neuropathy in Locally Advanced Rectal Cancer

• Published in: Advances in radiation oncology 2021-11, Vol.6 (6), p.100770-100770, Article 100770
• Main Authors: Lee, Charles T., M.D., Pharm. D, Denlinger, Crystal S., M.D, Meyer, Joshua E., M.D
• Format: Article
• Language: English
• Subjects: Hematology, Oncology, and Palliative Medicine; Teaching Case
• ISSN: 2452-1094; 2452-1094
• DOI: 10.1016/j.adro.2021.100770

AbstractIntroduction: Neoadjuvant chemoradiotherapy followed by surgery and adjuvant chemotherapy has historically been the preferred approach to locally advanced rectal adenocarcinoma. Radiation recall reaction (RRR) is a rare complication which occurs in a previously irradiated region of a patient following initiation of systemic therapy. Myositis as a RRR toxicity is an even more rare phenomenon. We report a case of a patient with locally advanced rectal cancer who experienced myositis and neuropathy limited to the lower extremities during the adjuvant chemotherapy phase of treatment for rectal cancer. Case: Our patient is a 57-year-old male with Stage IIIB low rectal adenocarcinoma who underwent standard neoadjuvant treatment with capecitabine and pelvic radiotherapy (RT) to approximately 50 Gy. He underwent abdominal perineal resection one month after completion of neoadjuvant therapy. Adjuvant FOLFOX began 5 weeks after surgery and was planned for eight cycles. Prior to his 4 th cycle, he developed weakness with hip adduction and extension and pain radiating from his hip down his anterior legs. These symptoms worsened despite dose reduction of his chemotherapy agents. He ultimately required a corticosteroid taper over 4 months and years of physical therapy to regain his lower extremity strength. After 5 years, his lower extremity pain persists. Conclusion: The onset, location, and quality of the myopathy and neuropathy in our patient cannot be explained by either RT or chemotherapy alone. Theories regarding the mechanism of RRR vary, but include subclinical tissue damage caused by RT which manifests only after additional toxicity from systemic therapy. Response to steroids is a hallmark of this condition. Early referral to physical therapy is also beneficial. Unfortunately, symptoms may not be fully reversible. The possibility of RRR myositis should be discussed with patients undergoing treatment for locally advanced rectal cancer.