J Korean Med Sci.  2001 Jun;16(3):328-334. 10.3346/jkms.2001.16.3.328.

5-Fluorouracil-induced leukoencephalopathy in patients with breast cancer

• Choi SM
• Lee SH
• Yang YS
• Kim BC
• Kim MK
• Cho KH

• KMID: 1129906
• DOI: http://doi.org/10.3346/jkms.2001.16.3.328

Abstract

The purpose of this study is to determine the characteristic clinical features, radiologic findings, and precipitating and prognostic factors in the patients with breast cancer and with 5-Fluorouracil (5-FU)-induced leukoencephalopathy. We reviewed the medical records of six breast cancer patients who developed leukoencephalopathy after chemotherapy which included 5-FU and also evaluated thorough neurological examinations including mini-mental status examination, cerebrospinal fluid studies, brain images and brain biopsies. Six patients exhibited slowly progressing neurologic symptoms characterized by the impairment of cognitive function, abulia, ataxic gait, and/or akinetic mutism. None of the patients had any specific causes or etiologic factors for leukoencephalopathy. Brain MRI in all patients showed diffuse periventricular white matter changes in the T2-weighted MR image. Brain biopsy in Patient 1 showed fragmented axonal fiber and minimally deprived myelination with many scattered macrophages. Five patients who treated with steroids at the onset of neurological symptoms showed clinical improvement, regardless of their age, sex, the pathology and stage of breast cancer, or the total dosage of chemotherapeutic agents. We conclude that leukoencephalopathy in these cases could be attributable to 5-FU neurotoxicity and suggest that the administration of steroids might be the treatment of choice.

Keyword

Leukoencephalopathy; Breast Neoplasms; Fluorouracil

MeSH Terms

Adenocarcinoma, Mucinous/complications/drug therapy
Adult
Anti-Inflammatory Agents, Steroidal/therapeutic use
Antineoplastic Agents/adverse effects/therapeutic use
Brain/*drug effects/metabolism/radiography
Breast Neoplasms/*complications/drug therapy
Carcinoma, Infiltrating Duct/*complications/drug therapy
Cyclophosphamide/adverse effects/therapeutic use
Epirubicin/adverse effects/therapeutic use
Female
Fluorouracil/*adverse effects/analogs & derivatives/therapeutic use
Glucocorticoids, Synthetic/therapeutic use
Human
Magnetic Resonance Imaging
Methylprednisolone/therapeutic use
Middle Age
Nervous System Diseases/chemically induced/drug therapy/metabolism/radiography
Prednisolone/therapeutic use