Visual system toxicity following intra-arterial chemotherapy

Area of Science:

• Ophthalmology
• Neuro-oncology
• Medical toxicology

Background:

• Gliomas are primary brain tumors that can affect the visual system.
• Intra-arterial chemotherapy is a treatment modality for certain brain tumors.
• Understanding the ocular toxicity of chemotherapy is crucial for patient management.

Purpose of the Study:

• To investigate the effects of intra-arterial chemotherapy agents, cisplatin and carmustine (BCNU), on the visual system in glioma patients.
• To evaluate retinal and optic nerve function using electroretinography (ERG) and clinical examination.
• To determine if chemotherapy delivery method (infra- vs. supra-ophthalmic) influences ocular toxicity.

Main Methods:

• Studied 29 consecutive patients with gliomas receiving intra-arterial chemotherapy.
• Administered infra-ophthalmic or supra-ophthalmic carotid infusion of cisplatin or carmustine (BCNU).
• Assessed visual pathway lesions clinically and retinal/optic nerve function using electroretinography.

Main Results:

• Infra-ophthalmic carotid infusion of cisplatin or BCNU led to anterior visual pathway lesions.
• Electroretinography revealed retinal dysfunction in patients without clinical abnormalities after infra-ophthalmic infusion.
• Supra-ophthalmic carotid infusion of cisplatin or BCNU did not cause significant retinal or optic nerve lesions; ERG was abnormal in only one patient.

Conclusions:

• Carmustine (BCNU) and cisplatin administered via intra-arterial chemotherapy can cause ischemic damage.
• These agents exhibit toxicity to retinal and neural tissues in glioma patients.
• The method of chemotherapy delivery (infra- vs. supra-ophthalmic) impacts ocular toxicity.