Central Nervous System Complications of Cancer Therapy
- Mikael L. Rinne, MD, PhD,
- Eudocia Q. Lee, MD, MPH,
- Patrick Y. Wen, MD
- Received 16 July 2011. Accepted 15 November 2011. Available online 26 April 2012.
Abstract
As more effective therapies prolong the survival of patients with cancer, therapy-related toxicities, particularly those affecting the central nervous system (CNS) become increasingly important. CNS complications can cause significant morbidity and can limit the dose or duration of otherwise effective treatments. Because effects on the CNS are disabling and often permanent and treatments remain limited, it is important that clinicians recognize the effects of cancer therapy on the CNS. Cytotoxic chemotherapy and radiation are well-known causes of neurotoxicity, but there is increasing recognition that novel therapies are also sources of adverse effects on the CNS. This review highlights the CNS complications that result from radiation, chemotherapy, and novel therapeutics.
Central nervous system (CNS) toxicity is a significant source of morbidity in the treatment of patients with cancer. Radiation, traditional cytotoxic chemotherapy, and novel biologic and targeted therapies all have recognized CNS side effects; and the risks of neurotoxicity can increase with combination therapy.1 Some CNS complications appear during treatment, while others present months or even years later. When patients present with neurologic deficits, practitioners need to recognize the signs and symptoms of treatment-related toxicity in order to intervene early and minimize neurologic damage. Treatment-related CNS toxicity needs to be distinguished from other direct or indirect effects of cancer, including tumor invasion, metastasis, metabolic derangements, infections, and paraneoplastic neurologic syndromes.
*For a PDF of the full article and accompanying viewpoint by Ivo Tremont-Lukats, click in the links to the left of this introduction.