Department of Radiotherapy (Unit 1), CMC Vellore, Vellore, 632004, India.
Department of Medical Oncology, CMC Vellore, Vellore, 632004, India.
J Egypt Natl Canc Inst. 2022 May 23;34(1):22. doi: 10.1186/s43046-022-00117-4.
The administration of 5-fluorouracil (5FU) in the treatment of gastrointestinal (GI) malignancies is associated with common side effects such as mucositis, diarrhoea, and myelosuppression, which are easily managed with supportive measures and dose adjustments. Cardiotoxicity and neurotoxicity are rare but reversible side effects of 5-FU and are treated with withdrawal of the drug and conservative measures. The presenting symptoms of 5-FU-induced leukoencephalopathy are often confusing and pose a diagnostic dilemma in routine clinical practice.
We report a series of five patients with GI malignancies who developed 5-FU-induced leukoencephalopathy.
All (n = 5) had Naranjo scores of 6-7, predictive of 5-FU-related adverse effects, with clinical and radiological findings suggestive of 5-FU-induced encephalopathy as described in prior literature. The median time to onset of symptoms from initiation of 5FU was 3 days (range: 2-4 days). All patients improved after conservative management with complete neurological recovery.
Prompt recognition of this rare yet severe adverse effect of 5-FU-based chemotherapy aids early withdrawal of the offending agent (5-FU) and timely initiation of supportive measures and helps plan alternative oncological interventions.
在胃肠道（GI）恶性肿瘤的治疗中，5-氟尿嘧啶（5FU）的给药与常见的副作用相关，如黏膜炎、腹泻和骨髓抑制，这些副作用可以通过支持性措施和剂量调整来轻松管理。心脏毒性和神经毒性是 5-FU 的罕见但可逆转的副作用，通过停止使用药物和保守治疗来治疗。5-FU 引起的脑白质病的表现症状通常令人困惑，在常规临床实践中构成诊断难题。
我们报告了一系列 5 例患有胃肠道恶性肿瘤的患者，他们发生了 5-FU 引起的脑白质病。
所有（n = 5）的 Naranjo 评分均为 6-7，预测与 5-FU 相关的不良反应，临床和影像学表现提示为 5-FU 诱导的脑病，如先前文献所述。从开始使用 5FU 到出现症状的中位时间为 3 天（范围：2-4 天）。所有患者经保守治疗后均有所改善，神经功能完全恢复。
及时认识到这种基于 5-FU 的化疗的罕见但严重的不良反应有助于早期停止使用有问题的药物（5-FU），并及时开始支持性措施，有助于计划替代肿瘤学干预措施。
