Symptom-Focused Approach.

Radiation recall reactions 1 Wu Y Qian Y Treatment for radiation-recall mucositis induced by anti-PD-1 blockade. Int J Radiat Oncol Biol Phys. 2023; 115: 7-8 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar are a rare but well-known phenomenon to oncologists. 2 McKay MJ Foster R Radiation recall reactions: An oncologic enigma. Crit Rev Oncol Hematol. 2021; 168103527 Crossref PubMed Scopus (12) Google Scholar Specifically, radiation recall mucositis (RRM) has been reported to be associated with antiprogrammed cell death 1 (anti-PD1) treatment before. 3 Waki Y Nobeyama Y Katsumata F et al. Case of carbon-ion radiation recall mucositis associated with anti-programmed cell death 1 treatment for paranasal sinuses melanoma. J Dermatol. 2021; 48: E502-E503 Crossref PubMed Scopus (1) Google Scholar Wu et al should be commended for their presentation on 3 informative cases of possible RRM associated with anti-PD1 treatment. Cases 2 and 3 developed severe sequela, including pharyngeal stenosis and fistula, which significantly impaired the patients’ quality of life. The mechanism of radiation recall reactions remains unclear. Thus, I will give symptomatic treatment, including nonsteroidal anti-inflammatory drugs and mouthwash with procaine for oropharyngeal pain. The systemic steroid might be reserved for severe cases. After the resolution of non–life-threatening RRM, the rechallenge of anti-PD1 treatment needs to be individualized based on the assumed efficacy of anti-PD1 treatment for the specific clinical scenario and the availability of alternative treatment. Most importantly, the decision should be shared decision making with patients’ preferences taken into account. Future research needs to elucidate the mechanism underlying radiation recall reaction and the interaction between radiation therapy and immunotherapy. Treatment for Radiation-Recall Mucositis Induced by Anti-PD-1 BlockadeInternational Journal of Radiation Oncology, Biology, PhysicsVol. 115Issue 1PreviewWe report 3 cases of radiation recall mucositis (RRM) induced by immunotherapy. Mr Z with nasopharyngeal carcinoma was first treated by radiation therapy and administrated with immunotherapy and chemotherapy when disease progressed with lung metastases (Fig. 1 A). A very good partial response was observed but the nasopharyngoscope revealed mucositis in the irradiated area where radiation therapy was applied 43 months ago (Fig. 2 A-C). Mucositis initially caused by radiation but recalled by immunotherapy is RRM. Full-Text PDF