Vincristine Related

Cisplatinum Related

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Late Effects

Peripheral Nervous System


Cisplatinum Related Neuropathy



  • Predominantly causes a sensory peripheral neuropathy affecting large nerve fibres3
  • The dorsal root ganglion is the primary target8
  • The dose-limiting neurotoxicity occurs at dosages above 200 mg/m25
  • 57-92% of patients treated with cisplatin develop peripheral neuropathy3



  • Much less likely to cause peripheral neuropathy than cisplatinum, unless doses are exceedingly high
  • Due to its stable cyclobutane leaving group and efficient excretion in urine1



  • Newer platinum analog that causes cisplatin-like peripheral neuropathy in 80% of patients
  • Also precipitates acute neuropathy (cold-induced dysthesias in hands/feet, jaw tightness, pharyngo-laryngo-dysesthesia) 30-60 min after administration if doses exceed 540 mg/m2.
  • This is thought to be due to the ability of oxaliplatin to alter axonal ion conductance and excitability3.



  • The mechanism of cisplatin-induced neuropathy is unknown, but may involve the binding of DNA in the dorsal root ganglion which triggers apoptosis and premature neuronal cell death5



The time course of cisplatin-induced symptoms is unusual compared to the peripheral neuropathy caused by other chemotherapeutic agents in that it occurs very late or after treatment has been completed3.

  • Paresthesias and dysesthesias in hands and feet
  • Position and vibration sense disturbed (large fibres affected)
  • Autonomic dysfunction is rare, but may involve orthostatic hypotension
  • Motor dysfunction may occur after substantial sensory loss



  • Sensory nerve conduction studies show:
    • Decrease or absence of sensory nerve action potentials
    • Delayed sensory nerve conduction velocities
  • Motor nerve conduction and EMG are normal


Risk factors:

  • Cumulative dose
    • Peripheral neuropathy occurs when the cumulative dose becomes greater than 300 mg/m2
    • Severe symptoms arise when greater than 500 mg/m23 
  • Type of platinum compound and daily dose3
  • Amofostine has a protective effect on subclinical neurotoxicity when given with cisplatinum.



  • Severe acute neurotoxicity usually resolves – two thirds of patients will have complete recovery3
  • 20-60% of patients may be left with persistent paresthesias following therapy


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