Capecitabine related neurotoxicity: Clinical and radiologic features

Published:September 30, 2022DOI:


      • Encephalopathy and leukoencephalopathy are the commonest clinico-radiologic features of capecitabine-related neurotoxicity.
      • Capecitabine-related neurotoxicity preponderated amongst females, but the clinico-radiologic features were similar in both genders.
      • Prognosis is excellent, and early recognition of neurotoxic symptoms and early cessation of capecitabine are important.



      To study the clinical and radiologic features of patients with capecitabine neurotoxicity.


      We performed a retrospective analysis and systematic review on the clinical and radiologic characteristics of all patients with capecitabine neurotoxicity reported in literature between 2003 and 2020.


      24 cases including our patient were retrospectively analysed, with their clinical and radiologic features summarized. Their median age was 59 years old (ranges from 31 to 82 years old). Encephalopathy was the predominant clinical symptom affecting more than half (15/24, 63%) of the patients. This was followed by cerebellar ataxia (10/24, 42%). Amongst the patients who had magnetic resonance imaging(MRI) brain imaging performed, majority of them (18/23, 78%) had acute radiologic abnormalities. Leukoencephalopathy was the commonest radiologic abnormality seen in more than half of the patients (15/23,65%). Despite the preponderance of female patients in our study, there were no significant statistical differences in the clinical and radiologic features. Short term prognosis was excellent with complete resolution of neurologic symptoms observed in nearly all of the patients (22/23, 96%).


      Capecitabine-related neurotoxicity is an uncommon cause of toxic encephalopathy, with a predilection for females. Clinical features are non-specific, with encephalopathy being the commonest. Prognosis remains good with timely recognition, and cessation of capecitabine. Future research looking into other pathogenic pharmacogenetic processes should be conducted for further elucidation of these associations.


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