5-fluorouracil [Neurosurgery Wiki]

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====== 5-fluorouracil ======


Over the past decade, researchers have found that [[neural stem cell]]s (NSCs) migrate toward inflammatory sites, including tumors. This insight has inspired research into the genetic engineering of human NSCs to express enzymes such as [[cytosine deaminase]] (CD) and [[thymidine kinase]] (TK). These enzymes enable these cells to convert the nontoxic prodrugs 5-fluorocytosine (5FC) and [[ganciclovir]] (GCV) into oncolytic 5-[[fluorouracil]] and GCV-triphosphate, respectively.
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Intralesional [[triamcinolone]] [[acetonide]] (TAC; a synthetic [[corticosteroid]]) and 5-[[fluorouracil]] (5-FU; a cytotoxic chemotherapy drug) are the [[medication]]s most commonly used to treat [[keloid scar]]s. 
Kaur et al. investigated the [[clinical efficacy]] of TAC compared with 5-FU. They included 40 patients in the study and divided them into two equal groups (n = 20 Group A; n = 20 Group B). Group A patients received 4 mg/cm2 or 0.1 ml/cm2 of intralesional TAC (40 mg/ml) at 3-week intervals. Group B patients received 10 mg/cm2 or 0.2 ml/cm2 of intralesional 5-FU (50 mg/ml) at 3-week intervals. 
They assessed the [[scar]] using the [[Vancouver Scar Scale]] (VSS), [[visual analog scale]] (VAS), and patient [[satisfaction]] score (PSS). They found that Group A patients had a lower VAS than Group B patients (2.09 vs. 3.18). They saw a reduction in the VSS in both treatment arms; however, they found that Group B patients had a more marked reduction in the VSS compared with Group A patients (2.57 vs. 2.68). The PSS was higher in Group A than in Group B (1.97 vs. 1.78). They concluded that intralesional 5-FU elicits a better response than intralesional TAC. Although 5-FU is less well tolerated and has more side effects than TAC, we found that 5-FU was more effective in resolving keloid scars. Notably, the PSS was higher in the TAC group, but the VSS and VAS were better in Group B
((Kaur A, Garg R, Mittal RK, Shah S, Patial T, Addiwal R. Comparative Efficacy of Intralesional Triamcinolone Acetonide and 5-Fluorouracil for Keloid Scars. Plast Aesthet Nurs (Phila). 2022 Oct-Dec 01;42(4):184-189. doi: 10.1097/PSN.0000000000000465. PMID: 36469388.)).