Sogabe Susumu, Yuki Satoshi, Takano Hironobu, Kobayashi Yoshimitsu, Nakatsumi Hiroshi, Sasaki Takahide, Kawamoto Yasuyuki, Fukushima Hiraku, Iwanaga Ichiro, Uehata Yasuko, Komatsu Yoshito, Asaka Masahiro
Dept. of Gastroenterology, Hokkaido University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2011 Aug;38(8):1375-7.
A40 -year-old woman visited our hospital with adenocaricinoma of the sigmoid colon with multiple liver metastases and ovarian metastasis. Because of a stenosis of the primary tumor, she underwent a colostomy before chemotherapy. 5-fluorouracil and irinotecan and leucovorin(FOLFIRI)was selected as first-line chemotherapy. At the start of chemotherapy, just after the end of irinotecan and leucovorin administration, the patient developed dysarthria. There were no neurological abnormalities or hematological abnormalities. The treatment was temporarily discontinued, and the dysarthria completely disappeared within 90 minutes. 5-fluorouracil was administered after the disappearance of dysarthria. Within 60 minutes of the administration of irinotecan and leucovorin at the second chemotherapy treatment, the patient developed dysarthria again. The patient had no neurological or hematological abnormalities. Magnetic resonance imaging(MRI)showed no abnormalities. The treatment was stopped and dysarthria disappeared within 60 minutes as it did the first time. At each time, no treatment for dysarthria was performed. This patient refused to continue irinotecan because of dysarthria. Therefore, chemotherapy without irinotecan was continued for the third time onward. In the previous literature, 8 cases of dysarthria caused by irinotecan were reported as a rare toxicity. In all cases, dysarthria was temporary and reversible. Because the mechanism of dysarthria is unclear, specific treatment and precaution for dysarthria is not recommended. Since dysarthria is reversible, however, irinotecan might be continued until progression.
一名40岁女性因乙状结肠癌伴多发肝转移及卵巢转移前来我院就诊。由于原发肿瘤狭窄，她在化疗前接受了结肠造口术。选择氟尿嘧啶、伊立替康和亚叶酸钙（FOLFIRI）作为一线化疗方案。化疗开始时，在伊立替康和亚叶酸钙给药结束后不久，患者出现构音障碍。无神经学异常或血液学异常。治疗暂时中断，构音障碍在90分钟内完全消失。构音障碍消失后给予氟尿嘧啶。在第二次化疗中，伊立替康和亚叶酸钙给药后60分钟内，患者再次出现构音障碍。患者无神经学或血液学异常。磁共振成像（MRI）未显示异常。治疗停止，构音障碍如首次一样在60分钟内消失。每次均未对构音障碍进行治疗。该患者因构音障碍拒绝继续使用伊立替康。因此，从第三次开始继续使用不含伊立替康的化疗方案。在既往文献中，有8例伊立替康引起的构音障碍作为罕见毒性被报道。在所有病例中，构音障碍都是暂时的且可逆的。由于构音障碍的机制尚不清楚，不建议针对构音障碍进行特殊治疗和预防措施。然而，由于构音障碍是可逆的，伊立替康可能可以持续使用至疾病进展。
