![]() Patient 1 then underwent chemoradiation with infusional 5-FU (2,250 mg weekly) and 54 Gy in 30 fractions to the pelvis using a 4-field box technique.Īround week 5 out of 6 of radiation treatment (after 41.4 Gy out of 54 Gy), he was noted to have erythema with minor blistering lesions over the head of the penis. A follow-up CT scan of his chest, abdomen, and pelvis showed no evidence of distant metastases. His chemotherapy was subsequently changed to FOLFOX for 4 more cycles, which the patient tolerated well. He was initially started on CAPEOX, but he was unable to tolerate capecitabine due to an adverse skin reaction on his hands and feet, and CAPEOX was stopped after 2 cycles. Patient 1 was offered total neoadjuvant therapy followed by surgery to treat his rectal cancer. Based on imaging findings, his rectal cancer was considered T3N0M0. MRI of the pelvis showed a mass-like lesion over the proximal and midrectum with a cranial caudal extension about 2.4 cm involving the proximal and midrectum with transmural involvement and without evidence of enlarged lymphadenopathy. A computed tomography (CT) scan of the chest/abdomen/pelvis showed no evidence of distant metastases. He did well until August 2019 when a follow-up screening colonoscopy examination identified a 1.5-cm sessile lesion at about 10 cm from anal verge biopsy confirmed invasive carcinoma. He underwent a screening colonoscopy examination in 2009 and was found to have cancer in situ in a resected polyp in the rectum. Patient 1 is a 59-year-old man with a diagnosis of T3N0M0 rectal cancer. Further review of the treatment plan and the literature suggest that this rare adverse effect-also known as balanitis, inflammation of the head of the penis-is associated with chemotherapy, specifically 5-FU and capecitabine. The immediate assumption was that this adverse reaction was caused by radiation. Here, we present 2 cases of patients receiving concurrent chemoradiation to the pelvis who developed blistering at the head of the penis. However, closer inspection may show this is not always the case. Generally, when patients have a skin reaction near the area of radiation treatment it is attributed to radiation. It is important to properly identify the causative agent for an adverse reaction, and failure to do so may not only worsen patients’ quality of life, but also delay or interrupt treatment. As a result, it can often be difficult to distinguish whether an adverse reaction to treatment is due to radiation or chemotherapy. Radiation is often combined with chemotherapy for concurrent chemoradiation treatment. 1 Severity can range from mild erythema to moist desquamation and ulceration. Skin changes caused by ionizing radiation are one of the most common side effects of radiation treatment, with radiation dermatitis occurring in about 85% to 95% of cancer patients receiving radiation treatment.
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