Complications of chemotherapy in patients with brain and spinal cord tumors

Abstract

Complications of chemotherapy in pediatric brain tumor patients tend to be acute and short-lived with some special exceptions such as permanent hearing impairment secondary to cisplatin, infertility and an increased risk of second primary neoplasms. Chemotherapy will be better tolerated and probably more effective in brain tumor patients following a major surgical resection, especially when agents such as cisplatin and cyclophosphamide are administered which require intensive intravenous hydration. Neoadjuvant or pre-radiotherapy chemotherapy administration may reduce chemotherapy-related side effects such as leukoencephalopathy secondary to high-dose intravenous methotrexate, neutropenia and thrombocytopenia following intensive chemotherapy, especially when craniospinal radiotherapy is required. The use of bone marrow ablative chemotherapy followed by autologous marrow rescue poses a new spectrum of organ toxicities. New supportive care measures significantly improved tolerance of chemotherapy such as mesna, a drug minimizing hemorrhagic cystitis following ifosfamide, ondonsetron, a highly effective antiemetic, and the hematopoietic growth factors such as G-CSF and GM-CSF which reduce the incidence and severity of symptomatic neutropenia. Chemotherapy may prolong life in patients with recurrent disease and contribute to curative therapy in newly diagnosed patients. The neurooncology community is becoming more familiar with the measures to improve its tolerance and thereby increase its efficacy.