The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Cardiogenic Shock after Chemotherapy with 5-Fluorouracil and Leucovorin in Rectal Cancer

5-Fluorouracil과 Leucovorin 항암요법 후 발생한 심인성 쇼크 1예

  • Yoon, Jee-Hee (Department of Internal Medicine, Chonnam National Universtiy Medical School) ;
  • Kim, Dong-Hyun (Department of Internal Medicine, Chonnam National Universtiy Medical School) ;
  • Kim, Seung-Hun (Department of Internal Medicine, Chonnam National Universtiy Medical School) ;
  • Choi, Won-Young (Department of Internal Medicine, Chonnam National Universtiy Medical School) ;
  • Koh, Young-Il (Department of Internal Medicine, Chonnam National Universtiy Medical School) ;
  • Chung, Ik-Joo (Department of Internal Medicine, Chonnam National Universtiy Medical School) ;
  • Bae, Woo-Kyun (Department of Internal Medicine, Chonnam National Universtiy Medical School)
  • 윤지희 (전남대학교 의과대학 내과학교실) ;
  • 김동현 (전남대학교 의과대학 내과학교실) ;
  • 김승훈 (전남대학교 의과대학 내과학교실) ;
  • 최원영 (전남대학교 의과대학 내과학교실) ;
  • 고영일 (전남대학교 의과대학 내과학교실) ;
  • 정익주 (전남대학교 의과대학 내과학교실) ;
  • 배우균 (전남대학교 의과대학 내과학교실)
  • Published : 2012.10.01
⟨ Previous Next ⟩

Abstract

A 51-year-old man with rectal adenocarcinoma was admitted to hospital for neoadjuvant concurrent chemoradiotherapy. Three days after receiving 5-fluorouracil (425 mg/$m^2$) and leucovorin (20 mg/$m^2$) chemotherapy, the patient complained of chest pain. The patient had no history of cardiac disease. Electrocardiography showed ST segment elevation in leads II, III, and aVF, but the cardiac enzymes were normal. Transthoracic echocardiography revealed global hypokinesia with marked systolic dysfunction (ejection fraction 21.55%) and coronary angiography showed no significant stenosis. Unfortunately, he died of cardiogenic shock, despite intensive medical treatment.

5-FU는 직장-대장암의 치료의 중심이 되는 항암제로 심장독성은 드물지만 심각한 부작용이다. 현재까지 심장독성을 예측할 수 있는 위험인자 및 발생기전이 알려져 있지 않으며, 가벼운 협심증 증상에서 사망까지 다양하게 발생할 수 있다. 국내에서는 5-FU 항암요법 후 심인성쇼크로 사망한 예가 보고된 바가 없고, 이에 저자들은 5-FU 항암요법 이후 심인성쇼크를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Dalzell JR, Samuel LM. The spectrum of 5-fluorouracil cardiotoxicity. Anticancer Drugs 2009;20:79-80. https://doi.org/10.1097/CAD.0b013e3283165f27
  2. Dent RG, McColl I. Letter: 5-fluorouracil and angina. Lancet 1975;1:347-348.
  3. Cerny J, Hassan A, Smith C, Piperdi B. Coronary vasospasm with myocardial stunning in a patient with colon cancer receiving adjuvant chemotherapy with FOLFOX regimen. Clin Colorectal Cancer 2009;8:55-58. https://doi.org/10.3816/CCC.2009.n.009
  4. Paiva CE, Paiva BS, Garita R, Michelin OC, Okoshi K. Acute coronary syndrome associated with continuous 5- fluorouracil infusion in a patient with metastatic colorectal cancer-a case report with a discussion on this clinical dilemma. J Gastrointest Cancer 2009;40:133-137. https://doi.org/10.1007/s12029-009-9101-z
  5. Jensen SA, Hasbak P, Mortensen J, Sorensen JB. Fluorouracil induces myocardial ischemia with increases of plasma brain natriuretic peptide and lactic acid but without dysfunction of left ventricle. J Clin Oncol 2010;28:5280-5286. https://doi.org/10.1200/JCO.2009.27.3953
  6. Shaib W, Lee V, Saif MW. Bolus 5-fluorouracil as an alternative modality to infusion 5-fluorouracil in a patient with rectal cancer and capecitabine-induced cardiotoxicity. In Vivo 2009;23:821-826.
  7. Weidmann B, Teipel A, Niederle N. The syndrome of 5-fluorouracil cardiotoxicity: an elusive cardiopathy. Cancer 1994;73:2001-2002. https://doi.org/10.1002/1097-0142(19940401)73:7<2001::AID-CNCR2820730736>3.0.CO;2-S
  8. Tsibiribi P, Descotes J, Lombard-Bohas C, et al. Cardiotoxicity of 5-fluorouracil in 1350 patients with no prior history of heart disease. Bull Cancer 2006;93:E27-E30.
  9. Tsibiribi P, Bui-Xuan C, Bui-Xuan B, et al. Cardiac lesions induced by 5-fluorouracil in the rabbit. Hum Exp Toxicol 2006;25:305-309. https://doi.org/10.1191/0960327106ht628oa
  10. Jensen SA, Søørensen JB. Risk factors and prevention of cardiotoxicity induced by 5-fluorouracil or capecitabine. Cancer Chemother Pharmacol 2006;58:487-493. https://doi.org/10.1007/s00280-005-0178-1