ABSTRACT
Neurotoxicity has been related to several chemotherapeutic agents. Effects are generally acute and often selflimited for the CNS, typified by encephalopathies attributed to electrolyte disturbance (e.g. with cisplatinum) or direct drug effects (e.g. methotrexate or ifosfamide). Reduction of CRT-induced brain damage has been used to justify the use of primary chemotherapy, especially for very young children, with malignant or low-grade brain tumors. Neurotoxicities of chemotherapy in this clinical setting may relate to later functional change as in doserelated sensorineural hearing loss associated with cisplatin. Hearing loss extending into the speech frequencies can limit normal cognitive development and academic progress in children. In one study of infants and very young children treated for brain tumors with preirradiation chemotherapy, physical and psychological growth was abnormal in the majority of children and showed no ‘catch up’ effect during the time that CRT was delayed.64 In the series of mixed intracranial tumors of children receiving neuraxis RT by Jannoun and Bloom,51
8 of the 13 patients also received chemotherapy. The chemotherapy was not specified, and patient function was not analyzed using chemotherapy exposure as a potential risk factor. Interpretation of the effects of whole-brain irradiation in this series is complicated by the high proportion of these patients who also received chemotherapy.
