Clinical characteristics of capecitabine-induced toxic leukoencephalopathy
OBJECTIVE To explore the clinical characteristics of capecitabine-induced toxic leukoencephalopathy.METHODS A total of 33 case reports of capecitabine-induced toxic leukoencephalopathy were retrieved from the databases of PubMed,Embase,VIP,CNKI and Wangfang.Another case was from Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.RESULTS There were 8 males and 26 females with a median age of 52.5(34,82)year.Clinical symptoms included slurred speech(64.71％),ataxia(17.65％),confusion(17.65％)and seizure(14.71％).And 87.10％of patients had clinical symptoms during initial chemotherapy of capecitabine and 64.52％occurred within 7 days of initial chemotherapy.Mag-netic resonance imaging(MRI)revealed abnormal signals in white matter,diffusion-weighted imaging(DWI),T2-weighted(T2WI)and fluid-attenuated inversion recovery sequences(FLAIR)hyperintensity and/or restricted diffusion and abnormalities in corpus callosum(n=26,76.47％).Other involved sites included centrum semiovale,deep white matter,subcortical white mat-ter of cerebral hemispheres,brain stem,thalami,corona radiate,corticospinal tract,middle cerebellar peduncles,basal ganglia and periventricular zones.Capecitabine withdrawal was primary treatment with a median time to regression of clinical symptoms of 3 day(10 h,20 day).And 32 cases(94.12％)showed a significant improvement or a complete imaging normalization within 6 months.CONCLUSION Capecitabine may cause toxic leukoencephalopathy.Early recognition and timely discontinuation of capecitabine lead to a better clinical prognosis.
capecitabineleukoencephalopathycytotoxic lesions of corpus callosumreversible posterior leukoencephalopa-thy syndromeneurotoxicity
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