5FU fluorouracil

5FU (fluorouracil)
Roche
Citations

Chen TC, Hinton DR, Leichman L, Atkinson RD, Apuzzo ML, Couldwell WT.Multifocal inflammatory leukoencephalopathy associated with levamisole and 5-fluorouracil: case report.Neurosurgery. 1994 Dec;35(6):1138-42; discussion 1142-3.PMID: 7885561 [PubMed - indexed for MEDLINE]

Levamisole and 5-fluorouracil have now become the standard chemotherapeutic regimen for patients with Stage III colon carcinoma. A case of multifocal inflammatory leukoencephalopathy secondary to levamisole alone or combination of levamisole and 5-fluorouracil is reported. Magnetic resonance imaging with gadolinium demonstrated multifocal contrast-enhancing frontal, parietal, occipital, and periventricular white matter lesions. A stereotactic biopsy revealed reactive gliosis and macrophage infiltration, without evidence of metastatic tumor. Despite continuation of 5-fluorouracil, resolution of contrast-enhancing lesions on magnetic resonance imaging without further neurological sequelae occurred when levamisole was stopped. The patient died with evidence of systemic metastasis 6 months later. Autopsy examination of the brain revealed multifocal demyelinating lesions, with no evidence of metastatic tumor. Immunoperoxidase studies of demyelinated lesions demonstrated infiltrating macrophages strongly positive for Class II antigens, interleukin-6, and interleukin-1 alpha. Surrounding astrocytes were positive for granulocyte macrophage colony-stimulating factor. Small numbers of perivascular T cells were present. This patient represents the first autopsy documented case of levamisole associated multifocal inflammatory leukoencephalopathy.

Critchley P, Abbott R, Madden FJ. Multifocal inflammatory leukoencephalopathy developing in a patient receiving 5-fluorouracil and levamisole.Clin Oncol (R Coll Radiol). 1994;6(6):406.PMID: 7873488 [PubMed - indexed for MEDLINE]
A single case of multifocal inflammatory leukoencephalopathy, which developed during a course of adjuvant chemotherapy with 5-fluorouracil (5FU) and levamisole is reported. Clinical features developed slowly and were not dramatic; this condition may therefore frequently be missed.

Enterline DS, Davey NC, Tien RD. Neuroradiology case of the day. Multifocal inflammatory leukoencephalopathy due to treatment with 5-fluorouracil and levamisole.AJR Am J Roentgenol. 1995 Jul;165(1):214-5. No abstract available.PMID: 7785607 [PubMed - indexed for MEDLINE]

Fassas AB, Gattani AM, Morgello S. Cerebral demyelination with 5-fluorouracil and levamisole.Cancer Invest. 1994;12(4):379-83. Review.PMID: 8032957 [PubMed - indexed for MEDLINE]

We report a patient who developed multifocal cerebral demyelination with the use of 5-fluorouracil, levamisole, and leucovorin as adjuvant treatment for intestinal adenocarcinoma. The clinical features were acute confusion, restlessness, ataxia, and slurred speech. Magnetic resonance imaging revealed multifocal enhancing white matter lesions. Brain biopsy showed a well-demarcated area of demyelination in cerebral white matter. The patient improved clinically and radiologically after cessation of chemotherapy and a short course of steroids. There have been only 4 previously reported cases of multifocal leukoencephalopathy related to the use of combination 5-fluorouracil and levamisole. The extensive use of these agents as adjuvant treatment for colorectal carcinoma may result in more frequent recognition of this form of neurological toxicity.

Ferroir JP, Fenelon G, Beaugerie L, Avenin Recoing D.[Multifocal inflammatory leukoencephalopathy: a complication of chemotherapy by fluorouracil and levamisole]Rev Neurol (Paris). 1994 Jun-Jul;150(6-7):471-4. French.PMID: 7747017 [PubMed - indexed for MEDLINE]
Two female patients with an adenocarcinoma of the colon (Duke stages B and C) underwent colectomy followed by adjuvant chemotherapy combining 5 fluorouracil (5 FU) and levamisole. Secondary neurological manifestations occurred in both patients including vertigo, nausea and vomiting, dizziness with loss of balance, slow ideation, impaired memory, headache and, on one case, central origin facial paralysis. Symptoms appeared between the 11th and 34th week of treatment. The patients had received 9 to 30 g 5 FU and 2.7 to 7.6 g levamisole. CT scan and/or MRI first suggested cerebral metastases then demyelinisation. The clinical signs disappeared spontaneously in less than one month. The brain images were unchanged. The 5 FU/levamisole combination was undoubtedly responsible for the neurological manifestations. Levamisole may have potentialized the effect of 5 FU leading to demyelinisation. Whether chemotherapy should be stopped or not is debated.
Fujikawa A, Tsuchiya K, Katase S, Kurosaki Y, Hachiya J. Diffusion-weighted MR imaging of Carmofur-induced leukoencephalopathy.Eur Radiol. 2001;11(12):2602-6.
Carmofur (1-hexylcarbamyl-5-fluorouracil), a derivative of 5-fluorouracil (5-FU), has been widely used in Japan as a postoperative adjuvant chemotherapy agent for colorectal and breast cancer. Periventricular hyperintensity on T2-weighted MR images in carmofur-induced leukoencephalopathy confront the physician with a broad range of differential diagnoses. We describe two cases of carmofur-induced leukoencephalopathy in which diffusion-weighted MR imaging revealed periventricular hyperintensity. We compared their findings with those of age-related periventricular hyperintensity in five patients and found discrepancies in signal intensity of periventricular areas. Our results suggest that diffusion-weighted MR imaging may be useful to differentiate carmofur-induced leukoencephalopathy from age-related periventricular hyperintensity.

Figueredo AT, Fawcet SE, Molloy DW, Dobranowski J, Paulseth JE. Disabling encephalopathy during 5-fluorouracil and levamisole adjuvant therapy for resected colorectal cancer: a report of two cases.Cancer Invest. 1995;13(6):608-11.PMID: 7583711 [PubMed - indexed for MEDLINE]

We observed leukoencephalopathy in 1 patient, and progressive dementia in another, during the administration of 5-fluorouracil (5-FU) and levamisole. A retrospective search, among 80 other patients with resected colorectal cancer receiving 5-FU and levamisole as adjuvant therapy, 166 resected malignant melanoma patients receiving adjuvant levamisole, and 254 advanced colorectal cancer patients receiving 5-FU often combined with leucovorin, for other cases of encephalopathy was negative. The frequency of this neurotoxicity is low (about 2% of patients receiving 5-FU and levamisole), but it appears specific for this combination of drugs. The lack of complete reversibility on stopping the drugs is worrisome, as this therapy is used to improve the curability of resected colon cancer.

Jarolim DR, Katz AL. Arthritis after chemotherapy.J Rheumatol. 1980 May-Jun;7(3):426-8. No abstract available.PMID: 7401080 [PubMed - indexed for MEDLINE]

PURPOSE: This report describes a previously unreported clinical phenomenon that occurs in some patients after completion of combination chemotherapy. METHODS AND RESULTS: Eight case reports are presented. Affected patients developed a syndrome of myalgias/arthralgias within several months of completing cyclophosphamide/fluorouracil (5FU)-containing adjuvant combination chemotherapy for breast cancer. These symptoms did not appear to be related to cancer recurrence or any common rheumatologic disorder. The syndrome generally resolved over several months. CONCLUSION: Postchemotherapy rheumatism is a syndrome of myalgias/arthralgias that usually develops 1 to 3 months after completion of adjuvant chemotherapy. Recognition of this syndrome can limit the need for extensive work-ups to exclude recurrent breast cancer or inflammatory rheumatologic diseases.

Galassi G, Tassone G, Sintini M, Spagnoli M, Bertolani L, Mavilla L. 5-Fluorouracil- and levamisole-associated multifocal leukoencephalopathy.Eur Neurol. 1996;36(4):244-6. No abstract available.PMID: 8814435 [PubMed - indexed for MEDLINE]

Luppi G, Zoboli A, Barbieri F, Crisi G, Piccinini L, Silingardi V. Multifocal leukoencephalopathy associated with 5-fluorouracil and levamisole adjuvant therapy for colon cancer. A report of two cases and review of the literature. The INTACC. Intergruppo Nazionale Terpia Adiuvante Colon Carcinoma.Ann Oncol. 1996 Apr;7(4):412-5. Review.PMID: 8805935 [PubMed - indexed for MEDLINE]

Matsumoto S, Nishizawa S, Murakami M, Noma S, Sano A, Kuroda Y.Carmofur-induced leukoencephalopathy: MRI.Neuroradiology. 1995 Nov;37(8):649-52.PMID: 8748897 [PubMed - indexed for MEDLINE]

Carmofur, a derivative of 5-fluorouracil, has recently been noted to have an infrequent but serious association with leukoencephalopathy. To our knowledge, there has been no report of early MRI findings in this leukoencephalopathy. We describe a case in which diffuse high signal intensity of the entire cerebral white matter, including the corpus callosum, was seen on T2-weighted magnetic resonance images. Although similar findings can be seen in many other diseases, carmofur-induced leukoencephalopathy should be suspected in a patient treated with carmofur. It is important to know the clinical and MRI characteristics of this condition, for early diagnosis and better prognosis.

Yasue M, Ishijima B, Sato J, Mizutani T, Morimatsu Y. [A case of toxic leucoencephalopathy induced by 5FU derivatives]No Shinkei Geka. 1985 Nov;13(11):1229-34. Japanese.PMID: 3937066 [PubMed - indexed for MEDLINE]
A case of toxic leucoencephalopathy induced by 5 FU derivatives is reported. A 46-year-old woman was diagnosed as having breast cancer, and radical mastectomy was performed on May, 1982. After operation, she was given irradiation and 5FU derivative (tegafur or carmofur) 600 mg and Nolvadex 20 mg (tamoxifen citrate) were administered every day. After taking the medication for a month, she began to stagger and developed a tremor in both arms. She was admitted to our hospital on August 16, because she showed evidence of dysarthria and memory disturbance in addition to her initial complaints. Soon after admission, she developed akinetic mutism, and metastasis in the brain stem was suspected. In spite of her severe condition, she was given radiation over the posterior fossa and continued the medication. On September 22, CT disclosed low density area in the centrum semiovale bilaterally. She died of DIC on November 30. An autopsy was performed. The brain weight was 1110 g and the outer surface of the brain was normal. In frontal cut surfaces stained with K.B., bilateral degeneration of the centrum semiovale was apparent. Microscopically, the degree of myelin degeneration was stronger than that of axon, and numerous fatty granular cells were found in the degenerated area. There were no bizarre shaped astrocytes, inclusion body or cellular infiltration. Fibrillary gliosis was scanty. No metastasis was found in the central nervous system or other organs. Based on these pathological findings and clinical history, toxic leucoencephalopathy induced by 5 FU derivatives was suggested.

Savarese DM, Gordon J, Smith TW, Litofsky NS, Licho R, Ragland R, Recht L. Cerebral demyelination syndrome in a patient treated with 5-fluorouracil and levamisole. The use of thallium SPECT imaging to assist in noninvasive diagnosis--a case report.Cancer. 1996 Jan 15;77(2):387-94.PMID: 8625249 [PubMed - indexed for MEDLINE]

BACKGROUND. The use of 5-fluorouracil (5-FU) and levamisole in patients with Stage III adenocarcinoma of the colon has now become standard. There have been several reports of a multifocal cerebral demyelination syndrome following 5-FU and levamisole administration. METHODS. We describe a patient who developed focal neurologic symptoms while being treated with levamisole and 5-FU in whom the diagnosis of central nervous system (CNS) metastases was considered. RESULTS. A magnetic resonance imaging (MRI) scan showed a diffuse, multifocal white matter process. Diagnostic evaluation did not support a diagnosis of CNS metastasis. 201Thallium chloride single photon emission computed tomography (SPECT) study was cold. A stereotactic brain biopsy disclosed demyelination but not tumor. The patient had complete functional resolution of symptoms with 1 month of dexamethasone therapy, although follow-up MRI scans have shown persistent abnormality on T2-weighted images. CONCLUSIONS. In patients receiving 5-FU and levamisole who develop focal neurologic symptoms with an abnormal MRI scan, the diagnosis of CNS metastasis should not be made without a thorough diagnostic evaluation. We suggest the use of 201thallium chloride SPECT imaging to support the diagnosis of multifocal leukoencephalopathy related to 5-FU and levamisole. In atypical cases, a stereotactic brain biopsy may be required for confirmation.