Watkin S W, Husband D J, Green J A, Warenius H M
University of Liverpool, Department of Radiation Oncology, U.K.
Eur J Cancer Clin Oncol. 1989 Sep;25(9):1303-10. doi: 10.1016/0277-5379(89)90077-1.
Eighteen consecutive cases of encephalopathy occurring after ifosfamide/mesna chemotherapy were prospectively assessed. No relationship was found with tumour type or chemotherapy response. Onset was from 12 to 146 (mean 46) h after the start of the infusion and median duration was 3 days (range 1-12). In two patients recovery was incomplete. A confusional state and agitation were the major clinical features. Plasma potassium fell from a mean of 4.12 mmol/l before chemotherapy to 2.94 mmol/l at the onset of encephalopathy (P less than 0.001) with plasma potassium less than 3.0 mmol/l in 10 patients. Duration of hypokalaemia was not related to duration of encephalopathy. Median survival following encephalopathy was 25 days. The incidence of encephalopathy in 82 patients treated on two protocols was 11% and the sensitivity of a published nomogram was 18%. It is concluded that ifosfamide/mesna encephalopathy is a serious complication which may be irreversible and remains difficult to predict.
对18例异环磷酰胺/美司钠化疗后发生脑病的连续病例进行了前瞻性评估。未发现与肿瘤类型或化疗反应有关。发病时间为输注开始后12至146小时（平均46小时），中位持续时间为3天（范围1至12天）。两名患者恢复不完全。意识模糊状态和躁动是主要临床特征。血浆钾从化疗前的平均4.12 mmol/L降至脑病发作时的2.94 mmol/L（P<0.001），10例患者血浆钾低于3.0 mmol/L。低钾血症的持续时间与脑病的持续时间无关。脑病后的中位生存期为25天。在两个方案治疗的82例患者中，脑病的发生率为11%，已发表的列线图的敏感性为18%。结论是，异环磷酰胺/美司钠脑病是一种严重并发症，可能不可逆转，且仍然难以预测。
