Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Jpn J Clin Oncol. 2013 May;43(5):569-70. doi: 10.1093/jjco/hyt032. Epub 2013 Mar 13.
We report the development of spinal infarction during adjuvant chemotherapy with tegafur, gimeracil and oteracil (TS-1) after surgery for lung adenocarcinoma. A 69-year-old female had a left upper lobectomy for pulmonary adenocarcinoma, T2aN0M0. Six weeks after the surgery, tegafur, gimeracil and oteracil were administered orally as adjuvant chemotherapy for 1 year. After 10 months of adjuvant chemotherapy, the patient suddenly showed signs of numbness and weakness in both lower limbs. The patient did not have a previous medical history, and was receiving only tegafur, gimeracil and oteracil with the stomach medication. Neurological findings showed muscle weakness, numbness and a loss of tendon reflex in both lower limbs, as well as bladder and rectal disturbance. Blood tests, brain magnetic resonance imaging and chest computed tomography showed no signs of abnormalities or metastasis. Magnetic resonance imaging of the spine showed a hyperintense lesion between the Th12 and L1 spinal levels by T2-weighted image. A spinal fluid test indicated no abnormalities, and cytological diagnosis was class II. Anti-aquaporin 4, anti-ganglioside and anti-neuronal autoantibodies were all negative. These results indicated that the patient had a spinal infarction, rather than myelitis or paraneoplastic neurological syndrome. The patient was treated with heparin and steroid pulse treatment followed by rehabilitation, and recovered sufficiently to be able to walk using a cane after 2 months. The development of spinal infarction during anti-cancer chemotherapy has not been previously reported. In this case, an association of spinal infarction with the use of adjuvant chemotherapy was strongly indicated due to the lack of abnormalities in coagulability, atherosclerotic lesions and aortic disease.
我们报告了一例肺腺癌手术后辅助化疗替加氟、吉美嘧啶和奥替拉西（TS-1）期间发生脊髓梗死。一位 69 岁女性因肺腺癌接受了左肺上叶切除术，T2aN0M0。手术后 6 周开始口服替加氟、吉美嘧啶和奥替拉西进行辅助化疗，共 1 年。辅助化疗 10 个月后，患者突然出现双下肢麻木无力的症状。患者既往无病史，仅接受替加氟、吉美嘧啶和奥替拉西联合胃药治疗。神经系统检查发现双下肢肌无力、麻木、腱反射消失，伴有膀胱和直肠功能障碍。血液检查、脑磁共振成像和胸部计算机断层扫描均未见异常或转移。脊柱磁共振成像显示 T12 至 L1 水平的 T2 加权图像呈高信号病变。脑脊液检查无异常，细胞学诊断为 II 级。抗水通道蛋白 4、抗神经节苷脂和抗神经元自身抗体均为阴性。这些结果表明患者发生了脊髓梗死，而非脊髓炎或副肿瘤性神经系统综合征。患者接受肝素和类固醇脉冲治疗以及康复治疗，2 个月后可借助手杖行走，恢复良好。在抗癌化疗期间发生脊髓梗死尚未见报道。在本例中，由于凝血功能、动脉粥样硬化病变和主动脉疾病均无异常，强烈提示脊髓梗死与辅助化疗有关。
