An exceptionally late and severe radiation recall dermatitis with chest-wall ulceration 32 years after breast radiotherapy: a case report and literature review.

Radiation recall phenomenon (RRP) is an inflammatory reaction occurring in previously irradiated tissues after exposure to certain drugs, and very late-onset cases are exceptionally rare. We report a 58-year-old woman with Human Epidermal Growth Factor Receptor 2 (HER2)-positive, estrogen receptor (ER) / progesterone receptor (PgR)-positive invasive ductal carcinoma of the left breast who had undergone contralateral mastectomy and radiotherapy 32 years earlier. During neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab, she developed rapidly progressive ulceration and necrosis confined to the prior radiation field on the right chest wall. Docetaxel and carboplatin were discontinued while trastuzumab and pertuzumab were continued. Intensive dermatologic management, including repeated surgical debridement and topical therapy, was required, and substantial epithelialization was achieved only after an approximately two-year course, highlighting a protracted recovery. The clinical course was considered most consistent with severe late-onset radiation recall dermatitis (RRD) superimposed on chronically vulnerable irradiated tissue. Clinicians should consider RRD during systemic therapy in patients with a history of radiotherapy, even decades after treatment, and should distinguish it from chronic radiation injury, infection, and recurrent cancer.