Neurological complications of cancer chemotherapy

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Curr Opin Oncol. 2006 Jul;18(4):321-324.

Neurological complications of cancer chemotherapy.

Hildebrand J.

aInstitut Jules Bordet, Brussels, Belgium bL'Hopital de la

Salpetiere, Paris, France.

PURPOSE OF REVIEW: To update central and peripheral nervous system

neurological manifestations caused by anticancer agents.

RECENT FINDINGS: Mostly unpredictable encephalopathy continues to be

sporadically reported even in patients treated systemically with

conventional chemotherapy doses. Recently, capecitabine, a 5-

fluorouracil prodrug, has been added to the list. Magnetic resonance

diffusion-weighted and fluid-attenuated inversion-recovery imaging

are useful in demonstrating chemotherapy-induced central nervous

system lesions. The pathogenesis of these lesions is often poorly

understood, and is probably multifactorial. A recent observation

indicates that genetic polymorphism for methionine is a potent risk

factor for methtrexate-induced central nervous system toxicity.

Chronic peripheral neuropathy still represents a major limiting

factor in a series of chemotherapeutic drugs, and the neuroprotective

effect of several older and newer agents is either deceptive or

insufficiently proven. In addition to chronic neuropathy,

oxaliplatine causes a unique acute syndrome which may respond to

calcium plus magnesium infusion.

SUMMARY: Neurotoxicity remains a major limitation of many drugs used

in cancer patients. Their list grows steadily, and magnetic resonance

imaging makes easier the recognition of central nervous system

toxicity. Synthesis and thorough clinical testing of neuroprotective

molecules remain a major challenge.