Posterior Reversible Encephalopathy Syndrome caused by TS-1 plus Cisplatin Combination Therapy of Advanced Gastric Cancer: Report of a Case

Kosuke Toda, Naoki Kakihara, Ken Yu, Wataru Ishii, Keigo Yamada, Katsumi Shimomura, Hiroomi Matsumura, Masaharu Ohgaki, Keigo Miyata and Atsushi Takenaka

Depertment of Surgery, Kyoto Second Red Cross Hospital

A 59-year-old woman with 0-IIc type gastric cancer underwent distal gastrectomy and lymphadenectomy followed by chemotherapy using TS-1 plus cisplatin postoperatively due to lymph node metastasis (#3, #4d, #5, #6, #7, #8a, #8p). The woman was administered TS-1 for 3 weeks at 80 mg/day, then intravenous infusion of 75 mg/day of cisplatin on day 8. On day 10 of course 2, she manifested systematic seizures, following which T2-weighted (T2W) magnetic resonance imaging (MRI) of the brain showed hyperintensity lesions in the bilateral occipital-parietal lobes. Chemotherapy was immediately stopped and her condition gradually improved. Based on typical findings in brain MRI and improved neurological signs, she was diagnosed with posterior reversible encephalopathy syndrome (PRES), which has been reported to be caused by immunosuppressive and chemotherapeutic drugs. It should be noted, however, that PRES caused by TS-1 plus cisplatin is extremely rare. Physicians should thus be alert to the potential adverse effects of chemotherapy on the central nervous system, and carefully consider the risks and benefits before starting treatment.

Key words
posterior reversible encephalopathy syndrome, TS-1, gastric cancer

Reprint requests
Kosuke Toda Department of Surgery, National Cancer Center Hospital East
6-5-1 Kashiwanoha, Kashiwa, 277-8577 JAPAN

Accepted
July 22, 2009

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