Central nervous system toxicity from cancer treatment

Neurologic complications of cancer therapy are an increasingly important concern in patient management. Improvements in systemic therapies and increasing use of local treatments to target such specific tumor sites as brain or leptomeningeal metastases have resulted in increased incidence of treatment toxicity in the central nervous system (CNS). Recognition of specific treatment-related toxicities, and more importantly, differentiation of treatment toxicity from reversible causes of neurologic dysfunction, are critical. This article reviews the evaluation and treatment of major CNS toxicities related to cancer treatment and conditions that present with similar signs and symptoms. The three most common of these, alterations in cognition and consciousness, seizures, and cerebellar dysfunction, are discussed. Prompt recognition of these problems and their causes will have an impact on patient care in all areas of oncology.