Overview of cisplatin-induced neurotoxicity and ototoxicity, and the protective agents.

The platinum agents (cisplatin, carboplatin and oxaliplatin) are among the most useful anticancer agents available to oncologists. The drugs have the potential to produce both mild and more serious side effects. However, in general, the platinum agents can be delivered with acceptable toxicity, even when used in combination chemotherapy regimens. Furthermore, with appropriate dose modifications, the large majority of patients who may benefit from this class of cytotoxic pharmaceutical drugs will be able to complete a planned therapeutic programme.

Toxicities of the platinum antineoplastic agents

• Swelling of the optic disc and loss of tendon reflexes developed in a 31/2-yearold girl after 11 high-dose courses of cisplatin ( cis -dichlorodiammine platinum [II]) therapy for recurrent sacrococcygeal teratoma. Postmortem examination demonstrated optic disc swelling; the spinal cord showed loss of myelinated fibers and gliosis of the dorsal columns. To our knowledge this case is the first in which the neuropathologic changes associated with cisplatin therapy have been demonstrated by postmortem examination.

Neurotoxic Effects of Cisplatin Therapy

Update on ocular complications of systemic cancer chemotherapy.

Purpose: To analyze the parameters that influence the risk of radiation-induced optic neuropathy (RION) after radiotherapy for head-and-neck tumors. Methods and Materials: Between 1964 and 2000, 273 patients with tumors of the nasopharynx, paranasal sinuses, nasal cavity, and hard palate adenoid cystic carcinomas were treated with curative intent and had radiation fields that included the optic nerves and/or chiasm. Patients were followed for at least 1 year after radiotherapy. Results: Radiation-induced optic neuropathy developed in 32 eyes of 24 patients (9%). The 5-year rates of freedom from RION according to the total dose and once- vs. twice-daily fractionation were as follows: ≤63 Gy once daily, 95%; ≤63 Gy twice daily, 98%; >63 Gy once daily, 78%; and >63 Gy twice daily, 91%. Multivariate analysis revealed that the total dose affected the risk of RION ( p = 0.0047), with patient age ( p = 0.0909), once-daily vs. twice-daily fractionation ( p = 0.0684), and overall treatment time ( p = 0.0972) were marginally significant. The use of adjuvant chemotherapy did not significantly influence the likelihood of developing RION. Conclusion: The likelihood of developing RION is primarily influenced by the total dose. Hyperfractionation may reduce the risk of experiencing this complication.

Does altered fractionation influence the risk of radiation-induced optic neuropathy?

Two cases of apparent ophthalmologic toxicity which occurred during treatment with cis-dichlorodiammineplatinum(II) (DDP) are described. In the first case, a patient with testicular carcinoma developed papilledema after three courses of DDP and adriamycin therapy. In the second case, a patient with breast cancer developed retrobulbar neuritis after three courses of DDP therapy. The differential diagnosis and possible explanation for these toxic effects are discussed.

Ophthalmologic toxicity after cis-dichlorodiammineplatinum(II) therapy.

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Ophthalmologic toxicity after cis-dichlorodiammineplatinum(II) therapy.