A Case of Advanced Recurrent Rectal Cancer With Posterior Reversible Encephalopathy Syndrome During S-1 + Irinotecan + Bevacizumab Therapy

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  • S-1＋Irinotecan＋Bevacizumab併用療法中に可逆性後頭葉白質脳症を発症した進行再発直腸癌の１例
  • S-1 + Irinotecan + Bevacizumab ヘイヨウ リョウホウ チュウ ニ カギャクセイ コウトウ ヨウ ハクシツ ノウショウ オ ハッショウ シタ シンコウ サイハツ チョクチョウ ガン ノ 1レイ

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Abstract

The patient was a 75-year-old man with advanced rectal cancer underwent abdominoperineal resection and lymph node dissection as conversion surgery after chemotherapy. Intraoperatively, lateral lymph node metastasis was evident in internal iliac vasculature and was deemed unresectable, so chemotherapy was continued after the operation. Due to an elevation in tumor markers and the appearance of lung metastasis, S-1 + irinotecan + bevacizumab therapy was performed as third-line therapy. On day 22 of the third course, he was transported to our hospital with abdominal pain and nausea. Contrast-enhanced computed tomography revealed adhesive bowel obstruction, and chemotherapy was discontinued. Restlessness and diplopia appeared after admission, and magnetic resonance imaging showed a high-intensity area on T2-fluid attenuated inversion recovery images, mainly in the occipital lobe. Because neurological symptoms and imaging findings improved with symptomatic treatment, we diagnosed him with posterior reversible encephalopathy syndrome. Although this disease can develop in association with chemotherapy and, for example, eclampsia, sepsis, renal failure, and autoimmune disease, it is rare and we report this case together with a review of the literature.

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