Abstract

Sorafenib has been established as one of the standard treatment for unresectable hepatocellular carcinoma, but the prognosis for this disease remains poor. Therefore, other treatment modalities such as local radiation therapy were widely investigated in many trials. As a result, the combination of Sorafenib and radiation therapy offered some promising results, but the distinct adverse effects of targeted therapeutics combined with radiation therapy were also observed. An undefined and rarely-reported skin reaction was observed in 2 elder patients with advanced hepatocellular carcinoma who underwent concurrent Sorafenib and radiation therapy. We describe this phenomenon as Sorafenib induced radiation in-field skin (SIRIS) reaction, and the clinical course and radiation dosimetry of these patients were reviewed. The development of SIRIS reaction was primarily limited within the radiation treatment fields, and it occurred at a relatively low dose during the courses of RT. The SIRIS reaction progressed in a radiation dose-dependent manner and was recovered spontaneously after 34 weeks of radiation therapy. The SIRIS reaction implicates a unique phenomenon that systemic skin reaction of targeted therapeutics, such as sorafenib, might be limited or exacerbated in specific regions by local radiation therapy.