イホスファミド脳症に対するメチレンブルーの治療的・予防的効果―骨軟部肉腫に対する化学療法での検討

Therapeutic and Preventive Effect of Methylene Blue against Ifosfamide Encephalopathy during Chemotherapy for Musculoskeletal Sarcomas

　骨軟部肉腫の40例に行われたイホスファミド併用化学療法120コースを対象に，イホスファミド脳症の頻度，重症度，および危険因子を調査した．また，メチレンブルーの脳症治療・予防効果についても検討した．脳症は，16例（40％），28コース（23.3％）に生じた．症状は，「傾眠」，「錯乱」，「気分変動―興奮」が多かった．重度の脳症はイホスファミドが9g/m²以上投与された時に生じた．シスプラチンの投与歴が脳症の有意な危険因子であった．メチレンブルーの治療効果は明らかではなかったが，予防効果が示された．

　We investigated the incidence, severity, and risk factors for ifosfamide encephalopathy in patients being treated for bone and soft tissue sarcoma and assessed the therapeutic and preventive effect of methylene blue against this adverse reaction. Ifosfamide encephalopathy developed in 16 (40％) of 40 cases and in 28 (23.3％) of 120 courses of treatment. The most common symptoms of encephalopathy were “somnolence”, “confusion”, and “mood alteration-agitation”. Severe encephalopathy had occurred in the patients treated with ifosfamide doses of 9g/m² or more. Previous cisplatin therapy was a significant risk factor. There was no clear therapeutic effect of methylene blue on the encephalopathy, but preventive efficacy was suggested.