APHON Pediatric Chemotherapy-Biotherapy Renewal

Figure 2. Nerve Cell or Neuron Each neuron has a cell body that includes a nucleus, axons, and dendrites. Communication between neurons occurs via axons and dendrites, extensions found on the nerve cell. Used with permission.

Procarbazine . Procarbazine is a cell-cycle-nonspecific antineoplastic agent; its use is indicated in the treatment of central nervous system tumors and lymphomas. Procarbazine is administered by mouth ( per os, PO) and should be given on an empty stomach for maximum absorption. Procarbazine readily crosses the blood-brain barrier. Neurotoxic effects of procarbazine include both central and peripheral nervous system toxicities. Toxicities can range from paresthesias, focal neurological deficits, and cognitive disturbances (e.g., depression, confusion, nightmares, and cerebral atrophy that can be detected via magnetic resonance imaging (MRI) (Verstappen et al., 2003). Peripheral nervous system toxicities can also include ataxia, orthostatic hypotension, weakness of intrinsic hand muscles, diminished reflexes, and peripheral neuropathy. Cisplatin . Cisplatin, an alkylating agent used to treat a variety of solid tumors, is administered intravenously and crosses the blood-brain barrier only minimally. However, it is able to produce toxicities of the central nervous system, including PRES. The patient may experience headache, cortical blindness, focal deficits, stroke, and seizures related to PRES, but these symptoms have been reported to be reversible (Sioka & Kyritsis, 2009). Peripheral neuropathy and cranial nerve deficits have also been reported to accompany the administration of cisplatin and at dose- limiting toxicities. Ataxic gait, paresthesia, and numbness are toxicities that may surface after the completion of treatment with cisplatin and may be attributed to axonal changes caused by cisplatin secondary to neuronal damage (Verstappen et al., 2003). Perhaps the most recognized peripheral neurotoxicity associated with cisplatin is the high-frequency hearing loss that is commonly seen. This ototoxicity is found in patients after cumulative exposure to the drug and may result in permanent hearing loss. This is significant for the pediatric patient population