Reactions 1407 - 23 Jun 2012

SAntineoplastics

Leukoencephalopathy in an elderly patient?: casereport

A 72-year-old man developed psychiatric symptomssuggestive of leukoencephalopathy during chemotherapyfor liver metastases from colon cancer.

The man received a bevacizumab with FOLFOX (folinicacid [leucovorin], fluorouracil, and oxaliplatin) regimen[routes and dosages not stated]. The regimen was effectivebut, starting from the fourth course of chemotherapy, hedeveloped psychiatric symptoms. These included making amistake with the hospitalisation date and entering a roomduring examination of another patient.Leukoencephalopathy was suspected.

The man’s chemotherapy regimen was suspended aftersix courses. A neurological exam revealed a Hasegawa’ssimple intelligence scale (HDS-R) score of 4. A brain MRIshowed atrophy of his left frontal lobe and left temporallobe. T2-weighted images did not show white matter highsignal intensity lesions. Differentiating the symptomsbetween a diagnosis of Alzheimer’s disease progression ordrug-induced leukoencephalopathy was not possible.Chemotherapy was suspended for 2 months during whichtime there were no significant changes in his psychiatricsymptoms. Findings before and after chemotherapy couldnot be compared so drug-induced leukoencephalopathywas not ruled out. FOLFOX/bevacizumab therapy wasresumed after explaining the risk to his family. At lastfollow-up, five further courses had been performed andthere were no changes in the MRI results and no worseningof his dementia. All his liver lesions, except for one, hadresolved.

Author comment: In the case at hand, the psychiatricsymptoms are considered to be caused by Alzheimer’sdisease, but because a comparison of before and after thechemotherapy cannot be made, the possibility could not beruled out that the psychiatric symptoms were the initialstages of leukoencephalopathy.Ganno H, et al. A case of encephalopathy that was suspected to be caused bychemotherapy for colon cancer. Gan to Kagaku Ryoho 38: 2322-4, No. 12, Nov2011 [Japanese; summarised from a translation] - Japan 803072241

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Reactions 23 Jun 2012 No. 14070114-9954/10/1407-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved