[Neurotoxicity and dermatologic toxicity of cancer chemotherapy]

Neurological dysfunction is a common adverse effect of many chemotherapeutic agents. Any part of the peripheral or central nervous system can be affected. Various clinical syndromes including encephalopathy, cerebellar syndrome, cranial neuropathy, seizure,myelopathy, and peripheral neuropathy commonly occur. In several drugs, neurotoxicity is a dose-limiting toxicity. Multiple factors such as cumulative dose, route of administration, drug metabolism and synergistic effects of other drugs or radiotherapy impact the incidence and severity of neurotoxicity. Much of the research in chemotherapy-induced neuropathies has been focused on the goal of ameliorating or preventing the neurotoxicity without altering the effectiveness of the medication. Various dermatologic complications of cancer chemotherapy such as extravasation, hyperpigmentation, nail change, radiation recall reaction and hypersensitivity reaction can occur. In extravasation, many cytotoxic agents are irritants or non-vesicants, however,a significant number of commonly used drugs are classified as vesicants, including the vinca alkaloids anthracyclines and taxanes. Extravasation of vesicant drugs into the subcutaneous tissue results in severe local pain and ulceration with progressive tissue destruction. Strategies to reduce the incidence of extravasation and minimize its associated morbidity are crucial to quality of life for cancer patients. The more common clinical features of chemotherapy-induced neurologic and dermatologic toxicities are discussed below.