Ms. S is a 52-year-old woman who was diagnosed with infiltrating ductal breast carcinoma two years prior. She was treated with mastectomy followed by focal radiation and FAC (5-fluorouracil, adriamycin, and cyclophosphamide). One year ago, she began experiencing headaches. A magnetic resonance imaging scan with gadolinium revealed a 2 cm enhancing mass in the left temporal lobe, and she received whole-brain irradiation.
ancer therapy uses a combination of treatment modalities such as surgery, radiation, and chemotherapy that may improve patient prognosis (Van Meir, Bellail, & Phyphanich, 2004;Butowski & Chang, 2005). However, combination therapy and extended survival are often associated with potential acute or delayed toxicities, including neurotoxicities. Patients with tumors of the nervous system are at particular risk for these complications. Traumatic or ischemic injuries are manifestations of central nervous system (CNS) toxicity as a result of brain-directed surgery to treat primary brain tumor or metastatic disease (Chi, Behin, & Delattre, 2008). Neurotoxicity related to chemotherapy is a common complication and often constitutes a dose-limiting toxicity. As newer agents and targeted therapies are developed, the number and range of potential neurotoxicities also increases (Dropcho, 2010a). Exposure of the CNS to therapeutic radiation, whether direct or incidental, is a potential risk for symptomatic neurologic injury (Dropcho, 2010b). Familiarity with the common neurologic toxicities experienced by patients with CNS tumors will assist the advanced practitioner in oncology in timely assessment and effective therapeutic interventions for these patients. Central Nervous System SURGERYMaximum safe resection is the most important goal of surgery for malignant glioma (Chang et al., 2003). This provides histologic diagnosis, reduces neurologic symptoms, and prolongs survival. Complications associated with craniotomy can be classified as neurologic, regional, and systemic (Table 1). Neurologic complications can be a consequence of direct injury to normal brain structures, cerebral edema, vascular injury, or hematoma (Warnick & Petr, 2008; Figure 1). There is also a predisposition to acquire skin organisms and subsequent infection when patients undergo procedures causing
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