Akpek G, Hartshorn K L
Department of Medicine, Boston Medical Center, MA, USA.
Cancer Chemother Pharmacol. 1999;43(2):157-61. doi: 10.1007/s002800050877.
Myocardial ischemia induced by 5-fluorouracil (5-FU) is a relatively rare, but potentially serious, occurrence. Some case reports have indicated that recurrent ischemia may be prevented if 5-FU is resumed after pretreatment with antianginal therapy.
A 54-year old woman was diagnosed with stage IIA squamous cell carcinoma of the anus. Treatment with concurrent radiation and chemotherapy (mitomycin-C and 5-FU) was initiated with curative intent.
The patient had no evidence of underlying coronary artery disease based on history, physical examination or ECG. Approximately 48 h after initiation of 5-FU infusion the patient developed anginal pain associated with ECG changes compatible with ischemia. After resolution of ischemia and ruling out of myocardial infarction, coronary arteriography demonstrated normal coronary arteries. In an attempt to prevent myocardial ischemia, calcium channel blocker and nitrate therapy was started, but anginal pain with ECG change recurred when 5-FU was resumed. This necessitated selection of an alternative chemotherapy regimen.
Even in the presence of normal coronary arteries, antianginal therapy may not preclude the occurrence of potentially serious 5-FU induced myocardial ischemia. For patients who experience 5-FU-induced myocardial ischemia, development of alternative chemotherapy regimens should be considered.
5-氟尿嘧啶（5-FU）诱导的心肌缺血是一种相对罕见但可能严重的情况。一些病例报告表明，如果在抗心绞痛治疗预处理后恢复使用5-FU，可预防复发性缺血。
一名54岁女性被诊断为肛门IIA期鳞状细胞癌。开始采用同步放疗和化疗（丝裂霉素-C和5-FU）进行治疗，目的是治愈。
根据病史、体格检查或心电图，该患者没有潜在冠状动脉疾病的证据。在开始输注5-FU约48小时后，患者出现与缺血性心电图改变相关的心绞痛。在缺血缓解并排除心肌梗死后，冠状动脉造影显示冠状动脉正常。为预防心肌缺血，开始使用钙通道阻滞剂和硝酸盐治疗，但恢复使用5-FU时，心绞痛伴心电图改变复发。这就需要选择替代化疗方案。
即使冠状动脉正常，抗心绞痛治疗也可能无法预防潜在严重的5-FU诱导的心肌缺血。对于经历5-FU诱导心肌缺血的患者，应考虑制定替代化疗方案。
