Furubayashi Nobuki, Negishi Takahito, Iwai Hidenori, Nagase Kei, Nakamura Motonobu
Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan.
Mol Clin Oncol. 2017 Aug;7(2):281-284. doi: 10.3892/mco.2017.1291. Epub 2017 Jun 13.
Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinicoradiological syndrome that is characterized by neurological symptoms, including seizures, headaches, visual abnormalities, confusion and encephalopathy, accompanied by vasogenic edema of the posterior white matter observed on neuroimaging. Sorafenib is an inhibitor of pro-angiogenic receptor tyrosine kinases, such as vascular endothelial growth factor receptor 2, platelet-derived growth factor receptor β, and vascular endothelial growth factor receptor 3. In the previous research literature, only one case of sorafenib-induced RPLS, in a patient with hepatocellular carcinoma, has been reported. The current report presents two cases of sorafenib-induced RPLS in patients with metastases from a renal cell carcinoma. In the first case, a 75-year-old female patient developed a fever, fell down and was unable to move her limbs as instructed after 11 days of sorefenib treatment. Brain magnetic resonance imaging (MRI) demonstrated no typical RPLS findings. As all of the symptoms were resolved after sorafenib discontinuation, sorafenib was restarted. However, the patient remained unable to walk steadily and to articulate properly after 10 days. MRI again demonstrated no notable findings, and her condition improved only after discontinuation of the sorafenib. In the second case, a 75-year-old male patient experienced a fall due to loss of consciousness. T2-weighted and fluid-attenuated inversion recovery MRI revealed high-intensity signals on both sides of the cerebellar hemisphere and pons, and also partially on both sides of the frontal lobe. At 33 days after sorafenib discontinuation, he had recovered sufficiently to walk by himself with a walker, and a repeat MRI revealed a significant improvement. Although one case took a longer time, both cases were fortunately reversible by discontinuation of sorafenib treatment and administration of combined-modality therapy (including oxygen, steroids, verapamil, digoxin and nicardipine hydrochloride). The oncology community should be alerted to this uncommon and life-threatening adverse event.
可逆性后部白质脑病综合征（RPLS）是一种罕见的临床放射学综合征，其特征为神经症状，包括癫痫发作、头痛、视觉异常、意识模糊和脑病，同时神经影像学检查显示后部白质存在血管源性水肿。索拉非尼是一种促血管生成受体酪氨酸激酶抑制剂，如血管内皮生长因子受体2、血小板衍生生长因子受体β和血管内皮生长因子受体3。在以往的研究文献中，仅报道过1例肝细胞癌患者发生索拉非尼诱导的RPLS。本报告介绍了2例肾细胞癌转移患者发生索拉非尼诱导的RPLS。第一例中，一名75岁女性患者在接受索拉非尼治疗11天后出现发热，摔倒后无法按指令移动四肢。脑磁共振成像（MRI）未显示典型的RPLS表现。由于停用索拉非尼后所有症状均得到缓解，因此重新开始使用索拉非尼。然而，10天后患者仍无法稳步行走且言语不清。MRI再次未显示明显异常，仅在停用索拉非尼后病情有所改善。第二例中，一名75岁男性患者因意识丧失而摔倒。T2加权和液体衰减反转恢复序列MRI显示小脑半球和脑桥两侧以及额叶两侧部分区域有高强度信号。索拉非尼停用33天后，他已恢复到能够借助助行器自行行走，重复MRI显示有显著改善。尽管其中1例恢复时间较长，但幸运的是，通过停用索拉非尼治疗并给予综合治疗（包括吸氧、类固醇、维拉帕米、地高辛和盐酸尼卡地平），两例患者的病情均得以逆转。肿瘤学界应警惕这种罕见且危及生命的不良事件。
