A40 -year-old woman visited our hospital with adenocaricinoma of the sigmoid colon with multiple liver
metastases and ovarian
metastasis. Because of a
stenosis of the primary
tumor, she underwent a
colostomy before
chemotherapy.
5-fluorouracil and
irinotecan and
leucovorin(FOLFIRI)was selected as first-line
chemotherapy. At the start of
chemotherapy, just after the end of
irinotecan and
leucovorin administration, the patient developed
dysarthria. There were no neurological abnormalities or hematological abnormalities. The treatment was temporarily discontinued, and the
dysarthria completely disappeared within 90 minutes.
5-fluorouracil was administered after the disappearance of
dysarthria. Within 60 minutes of the administration of
irinotecan and
leucovorin at the second
chemotherapy treatment, the patient developed
dysarthria again. The patient had no neurological or hematological abnormalities. Magnetic resonance imaging(MRI)showed no abnormalities. The treatment was stopped and
dysarthria disappeared within 60 minutes as it did the first time. At each time, no treatment for
dysarthria was performed. This patient refused to continue
irinotecan because of
dysarthria. Therefore,
chemotherapy without
irinotecan was continued for the third time onward. In the previous literature, 8 cases of
dysarthria caused by
irinotecan were reported as a rare toxicity. In all cases,
dysarthria was temporary and reversible. Because the mechanism of
dysarthria is unclear, specific treatment and precaution for
dysarthria is not recommended. Since
dysarthria is reversible, however,
irinotecan might be continued until progression.