key: cord-1032595-5lsmggg2
authors: Soyfer, Viacheslav; Gutfeld, Orit; Shamai, Sivan; Schlocker, Albert; Merimsky, Ofer
title: COVID-19 Vaccine Induced Radiation Recall Phenomenon
date: 2021-03-04
journal: Int J Radiat Oncol Biol Phys
DOI: 10.1016/j.ijrobp.2021.02.048
sha: af53919bb14e5778e69eb7e7577722067a3a7cf5
doc_id: 1032595
cord_uid: 5lsmggg2

Radiation Recall Phenomenon (RRP) is an uncommon, late occurring, acute inflammatory skin reaction that emerges in localized areas coincident with previously irradiated radiotherapy (RT) treatment fields. RRP has been known to be triggered by a number of chemotherapy agents. To the best of our knowledge, this report is the first description of RRP following administration of the Pfizer-BioNTech vaccine for COVID-19, or any other currently available vaccine against COVID-19. Acute skin reactions were observed in two radiotherapy patients with differing timelines of RT and vaccinations. In both cases however, the RRP presented within days of the patient receiving the second dose of vaccine. For each RT course the treatment planning dosimetry of the radiation fields was compared to the area of the observable RRP. RRP developed within the borders of treatment fields where prescription dose constraints were prioritized over skin sparing. Our observation is currently limited to two patients. The actual incidence of RRP in conjunction with Pfizer-BioNTech vaccine or any other vaccine against Covid-19, is unknown. For cancer patients being treated with radiation with significant dose to skin, consideration should be given to the probability of RRP side-effects from vaccinations against COVID-19.

To the best of our knowledge, this report is the first description of RRP following administration 6 of the Pfizer-BioNTech vaccine for COVID-19, or any other currently available vaccine against 7 COVID-19. Acute skin reactions were observed in two radiotherapy patients with differing 8 timelines of RT and vaccinations. In both cases however, the RRP presented within days of the 9 patient receiving the second dose of vaccine.

For each RT course the treatment planning dosimetry of the radiation fields was compared to the 11 area of the observable RRP. RRP developed within the borders of treatment fields where 12 prescription dose constraints were prioritized over skin sparing.

Our observation is currently limited to two patients. The actual incidence of RRP in 14 conjunction with Pfizer-BioNTech vaccine or any other vaccine against Covid-19, is unknown.

For cancer patients being treated with radiation with significant dose to skin, consideration 16 should be given to the probability of RRP side-effects from vaccinations against COVID-19. Radiation Recall Phenomenon (RRP) is a late effect, acute skin reaction associated with 20 therapeutic irradiation, triggered by something other than radiation. It usually appears more than 21 J o u r n a l P r e -p r o o f one week after the completion of radiation therapy and is typically localized to the radiotherapy field entry points. The RRP is frequently wrongly misinterpreted for radio-sensitization if the 23 skin reaction appears within 7 days following radiation treatment (1).

The radiation recall syndrome was first described by D'Angio et al in 1959 (2). 25 Though oncologists are generally aware of RRP, little is known about its pathophysiology. (mixed 9 and 12 MeV) prescribed to 90% isodose level, with 0.5 cm bolus over the entire field 61 was delivered to his back (Fig 1a) .

information/covid-19-vaccine-patients-cancer 

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