Saito Masaaki, Kiyozaki Hirokazu, Obitsu Tamotu, Imoto Hirofumi, Taniyama Yusuke, Takata Osamu, Rikiyama Toshiki
Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
BMC Cancer. 2016 Mar 17;16:233. doi: 10.1186/s12885-016-2255-8.
Systemic chemotherapy combined with steroids used as prophylactic antiemetics have been reported to induce immunosuppression. Further, herpes simplex virus-1 (HSV-1) infection has been reported to occur in patients with small cell carcinomas after chemoradiotherapy that includes brain irradiation. Here, we report a case of HSV-1 encephalitis that occurred in a patient undergoing chemoradiotherapy for advanced esophageal cancer.
A 77-year-old woman received chemoradiotherapy (5-fluorouracil, 700 mg/m(2); cisplatin, 70 mg/m(2); and radiotherapy, 60 Gy in total) for stage III esophageal cancer. The total radiation dose was administered concurrently with the first two courses of chemotherapy, together with dexamethasone as a prophylactic antiemetic. Two days before completion of the fourth course of chemotherapy, the patient developed acute neurological symptoms of disorientation, clouding of consciousness, and fever. T2-weighted magnetic resonance imaging showed a high intensity area in the bilateral temporal lobes and insular cortex. Furthermore, DNA PCR testing of cerebrospinal fluid showed clear positivity for HSV-1 DNA, and the patient was diagnosed with herpetic encephalitis. Intravenous administration of acyclovir for 3 weeks led to gradual improvement of consciousness, and the patient was able to respond to verbal cues.
In advanced esophageal cancer patients, standard treatment involves chemoradiotherapy and surgery. However, primary infection with or reactivation of endogenous latent HSV-1 in the brain cortex during chemoradiotherapy combined with administration of a steroid may compromise the benefits of treatment.
据报道，全身化疗联合使用类固醇作为预防性止吐药可导致免疫抑制。此外，据报道，在包括脑部放疗的放化疗后，小细胞癌患者会发生单纯疱疹病毒1型（HSV-1）感染。在此，我们报告1例接受晚期食管癌放化疗的患者发生HSV-1脑炎的病例。
一名77岁女性因III期食管癌接受放化疗（5-氟尿嘧啶，700mg/m²；顺铂，70mg/m²；放疗，总量60Gy）。总放射剂量与前两个疗程的化疗同时给予，同时给予地塞米松作为预防性止吐药。在完成第四个疗程化疗的前两天，患者出现定向障碍、意识模糊和发热等急性神经症状。T2加权磁共振成像显示双侧颞叶和岛叶皮质有高强度区域。此外，脑脊液的DNA聚合酶链反应检测显示HSV-1 DNA呈明显阳性，该患者被诊断为疱疹性脑炎。静脉注射阿昔洛韦3周后意识逐渐改善，患者能够对言语提示做出反应。
在晚期食管癌患者中，标准治疗包括放化疗和手术。然而，在放化疗联合使用类固醇期间，脑皮质内源性潜伏HSV-1的原发性感染或再激活可能会损害治疗效果。
