Neurological complications of cancer chemotherapy.
OBJECTIVE
To update central and peripheral nervous system neurological manifestations caused by anticancer agents.


RESULTS
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.


CONCLUSIONS
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.
Hildebrand
Jerzy
J
Institut Jules Bordet, Brussels, Belgium. hildebrand@skynet.be
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000494:pharmacology; D000069287:Capecitabine; D002490:Central Nervous System / Q000187:drug effects*; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000494:pharmacology; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000494:pharmacology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009369:Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D018696:Neuroprotective Agents / Q000494:pharmacology; D017933:Peripheral Nervous System / Q000187:drug effects*; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*; D014810:Vitamin E / Q000378:metabolism
D000970:Antineoplastic Agents; D018696:Neuroprotective Agents; D003841:Deoxycytidine; D014810:Vitamin E; D000069287:Capecitabine; D005472:Fluorouracil