Download PDF
Semin Neurol 2004; 24(4): 347-362
DOI: 10.1055/s-2004-861530
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Brain Metastases

Francois G. El Kamar1 , Jerome B. Posner1
  • 1Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York
Further Information

Publication History

Publication Date:
07 January 2005 (online)

    Permissions and Reprints

ABSTRACT

Approximately 10% of patients with cancer develop brain metastases. Although usually appearing late in the course of the disease, the brain metastasis may be present before the primary cancer has been identified and may present as a single lesion or as multiple lesions. The diagnostic and therapeutic approach depends on the number and location of brain lesions and the stage of the cancer. Patients with brain metastases are rarely cured. However, appropriate treatment can improve both the quality and duration of the patient's life. Treatment must be directed not only at the brain metastasis (definitive care), but also at a multitude of other symptoms that plague patients with cancer and brain metastases (supportive care). Judicious selection of pharmacological agents can effectively treat many serious symptoms in patients with brain metastases, but injudicious selection of pharmacological agents, through side effects, may make the patients' quality of life worse. This article reviews some aspects of both definitive and supportive care with particular attention to the side effects of some commonly used pharmacological agents.

KEYWORDS

Brain metastasis - supportive care - corticosteroids - seizures - venous thromboembolism

REFERENCES

  • 1 Posner J B, Chernik N L. Intracranial metastases from systemic cancer.  Adv Neurol. 1978;  19 579-592
    PubMedGoogle Scholar
  • 2 Cairncross J G, Kim J-H, Posner J B. Radiation therapy of brain metastases.  Ann Neurol. 1980;  7 529-541
    CrossrefPubMedGoogle Scholar
  • 3 Katz A, Zalewski P. Quality-of-life benefits and evidence of antitumour activity for patients with brain metastases treated with gefitinib.  Br J Cancer. 2003;  89(S2) S15-S18
    PubMedGoogle Scholar
  • 4 Posner J B. Neurologic Complications of Cancer. Philadelphia; F.A. Davis 1995
    Google Scholar
  • 5 Lassman A B, DeAngelis L M. Brain metastases.  Neurol Clin. 2003;  21 1-23
    CrossrefPubMedGoogle Scholar
  • 6 Schiff D, Wen P Y. Cancer Neurology in Clinical Practice. 1st ed. Totowa, NJ; Humana Press Inc. 2002
    Google Scholar
  • 7 Wen P Y, Marks P W. Medical management of patients with brain tumors.  Curr Opin Oncol. 2002;  14 299-307
    CrossrefPubMedGoogle Scholar
  • 8 Chang E L, Hassenbusch III S J, Shiu A S et al.. The role of tumor size in the radiosurgical management of patients with ambiguous brain metastases.  Neurosurgery. 2003;  53 272-280
    CrossrefPubMedGoogle Scholar
  • 9 Bindal A K, Bindal R K, Hess K R et al.. Surgery versus radiosurgery in the treatment of brain metastasis.  J Neurosurg. 1996;  84 748-754
    CrossrefPubMedGoogle Scholar
  • 10 Brown P D, Brown C A, Pollock B E, Gorman D A, Foote R L. Stereotactic radiosurgery for patients with “radioresistant” brain metastases.  Neurosurgery. 2002;  51 656-665
    CrossrefPubMedGoogle Scholar
  • 11 Pavlidis N, Briasoulis E, Hainsworth J et al.. Diagnostic and therapeutic management of cancer of an unknown primary.  Eur J Cancer. 2003;  39 1990-2005
    CrossrefPubMedGoogle Scholar
  • 12 Shu H-KG, Sneed P K, Shiau C-Y et al.. Factors influencing survival after gamma knife radiosurgery for patients with single and multiple brain metastases.  Cancer J Sci Am. 1996;  2 335-342
    PubMedGoogle Scholar
  • 13 Van de Pol M, Van Aalst V C, Wilmink J T et al.. Brain metastases from an unknown primary tumour: which diagnostic procedures are indicated?.  J Neurol Neurosurg Psychiatry. 1996;  61 321-323
    PubMedGoogle Scholar
  • 14 Sneed P K, Lamborn K R, Forstner J M et al.. Radiosurgery for brain metastases: is whole brain radiotherapy necessary?.  Int J Radiat Oncol Biol Phys. 1999;  43 549-558
    CrossrefPubMedGoogle Scholar
  • 15 Abrey L E, Christodoulou C. Temozolomide for treating brain metastases.  Semin Oncol. 2001;  28 34-42
    PubMedGoogle Scholar
  • 16 Cortes J, Rodriguez J, Aramendia J M et al.. Front-line paclitaxel/cisplatin-based chemotherapy in brain metastases from non-small-cell lung cancer.  Oncology. 2003;  64 28-35
    CrossrefPubMedGoogle Scholar
  • 17 Corcoran M E. Polypharmacy in the older patient with cancer.  Cancer Control. 1997;  4 419-428
    PubMedGoogle Scholar
  • 18 Lu S, Ahn D, Johnson G et al.. Peritumoral diffusion tensor imaging of high-grade gliomas and metastatic brain tumors.  AJNR Am J Neuroradiol. 2003;  24 937-941
    PubMedGoogle Scholar
  • 19 Machein M R, Plate K H. VEGF in brain tumors.  J Neurooncol. 2000;  50 109-120
    CrossrefPubMedGoogle Scholar
  • 20 Lieberman A, LeBrun Y, Glass P et al.. Use of high-dose corticosteroids in patients with inoperable brain tumors.  J Neurol Neurosurg Psychiatry. 1977;  40 678-682
    CrossrefPubMedGoogle Scholar
  • 21 Wooldridge J E, Anderson C M, Perry M C. Corticosteroids in advanced cancer.  Oncology (Huntingt). 2001;  15 225-234
    PubMedGoogle Scholar
  • 22 Mertens W C, Higby D J, Brown D et al.. Improving the care of patients with regard to chemotherapy-induced nausea and emesis: the effect of feedback to clinicians on adherence to antiemetic prescribing guidelines.  J Clin Oncol. 2003;  21 1373-1378
    CrossrefPubMedGoogle Scholar
  • 23 Heiss J D, Papavassiliou E, Merrill M J et al.. Mechanism of dexamethasone suppression of brain tumor-associated vascular permeability in rats-involvement of the glucocorticoid receptor and vascular permeability factor.  J Clin Invest. 1996;  98 1400-1408
    CrossrefPubMedGoogle Scholar
  • 24 Batchelor T T, Taylor L P, Thaler H T et al.. Steroid myopathy in cancer patients.  Neurology. 1997;  48 1234-1238
    PubMedGoogle Scholar
  • 25 Sieb J P, Gillessen T. Iatrogenic and toxic myopathies.  Muscle Nerve. 2003;  27 142-156
    CrossrefPubMedGoogle Scholar
  • 26 DiGiovanni S, Molon A, Broccolini A et al.. Constitutive activation of MAPK cascade in acute quadriplegic myopathy.  Ann Neurol. 2004;  55 195-206
    CrossrefPubMedGoogle Scholar
  • 27 Dougherty J A. Risedronate for the prevention and treatment of corticosteroid-induced osteoporosis.  Ann Pharmacother. 2002;  36 512-516
    CrossrefPubMedGoogle Scholar
  • 28 Assouline-Dayan Y, Chang C, Greenspan A et al.. Pathogenesis and natural history of osteonecrosis.  Semin Arthritis Rheum. 2002;  32 94-124
    CrossrefPubMedGoogle Scholar
  • 29 Nielsen G L, Sorensen H T, Mellemkjoer L et al.. Risk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: A register-based cohort study.  Am J Med. 2001;  111 541-545
    CrossrefPubMedGoogle Scholar
  • 30 Metz L M, Sabuda D, Hilsden R J et al.. Gastric tolerance of high-dose pulse oral prednisone in multiple sclerosis.  Neurology. 1999;  53 2093-2096
    CrossrefPubMedGoogle Scholar
  • 31 Niv Y, Zlatkis L, Kosakov K. Cimetidine and encephalopathy.  Ann Intern Med. 1986;  105 977
    PubMedGoogle Scholar
  • 32 Wade E E, Rebuck J A, Healey M A et al.. H(2) antagonist-induced thrombocytopenia: is this a real phenomenon?.  Intensive Care Med. 2002;  28 459-465
    CrossrefPubMedGoogle Scholar
  • 33 Rostom A, Dube C, Wells G et al.. Prevention of NSAID-induced gastroduodenal ulcers.  Cochrane Database Syst Rev. 2002;  CD002296
    PubMedGoogle Scholar
  • 34 Weiner H L, Rezai A R, Cooper P R. Sigmoid diverticular perforation in neurosurgical patients receiving high-dose corticosteroids.  Neurosurgery. 1993;  33 40-43
    CrossrefPubMedGoogle Scholar
  • 35 Fadul C E, Lemann W, Thaler H T et al.. Perforation of the gastrointestinal tract in patients receiving steroids for neurological disease.  Neurology. 1988;  38 348-352
    PubMedGoogle Scholar
  • 36 De Quervain D JF, Henke K, Aerni A et al.. Glucocorticoid-induced impairment of declarative memory retrieval is associated with reduced blood flow in the medial temporal lobe.  Eur J Neurosci. 2003;  17 1296-1302
    CrossrefPubMedGoogle Scholar
  • 37 Schiff D. Pneumocystis pneumonia in brain tumor patients: risk factors and clinical features.  J Neurooncol. 1996;  27 235-240
    CrossrefPubMedGoogle Scholar
  • 38 Sirois F. Steroid psychosis: a review.  Gen Hosp Psychiatry. 2003;  25 27-33
    CrossrefPubMedGoogle Scholar
  • 39 Patten S B, Neutel C I. Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management.  Drug Saf. 2000;  22 111-122
    CrossrefPubMedGoogle Scholar
  • 40 Oberndorfer S, Schmal T, Lahrmann H et al.. The frequency of seizures in patients with primary brain tumors or cerebral metastases. An evaluation from the Ludwig Boltzmann Institute of Neuro-Oncology and the Department of Neurology, Kaiser Franz Josef Hospital Vienna.  Wien Klin Wochenschr. 2002;  114 911-916
    PubMedGoogle Scholar
  • 41 Vecht C J, Wagner G L, Wilms E B. Interactions between antiepileptic drugs and chemotherapeutic agents.  Neurology. 2003;  2 404-409
    CrossrefPubMedGoogle Scholar
  • 42 Glantz M J, Cole B F, Forsyth P A et al.. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors-report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2000;  54 1886-1893
    CrossrefPubMedGoogle Scholar
  • 43 Mamon H J, Wen P Y, Burns A C et al.. Allergic skin reactions to anticonvulsant medications in patients receiving cranial radiation therapy.  Epilepsia. 1999;  40 341-344
    CrossrefPubMedGoogle Scholar
  • 44 Temkin N R. Antiepileptogenesis and seizure prevention trials with antiepileptic drugs: meta-analysis of controlled trials.  Epilepsia. 2001;  42 515-524
    CrossrefPubMedGoogle Scholar
  • 45 Foy P M, Chadwick D W, Rajgopalan N et al.. Do prophylactic anticonvulsant drugs alter the pattern of seizures after craniotomy?.  J Neurol Neurosurg Psychiatry. 1992;  55 753-757
    CrossrefPubMedGoogle Scholar
  • 46 Lee A Y, Levine M N. Venous thromboembolism and cancer: risks and outcomes.  Circulation. 2003;  107 I17-I21
    PubMedGoogle Scholar
  • 47 Chan A T, Atiemo A, Diran L K et al.. Venous thromboembolism occurs frequently in patients undergoing brain tumor surgery despite prophylaxis.  J Thromb Thrombolysis. 1999;  8 139-142
    CrossrefPubMedGoogle Scholar
  • 48 Hamilton M G, Hull R D, Pineo G F. Venous thromboembolism in neurosurgery and neurology patients: a review.  Neurosurgery. 1994;  34 280-296
    CrossrefPubMedGoogle Scholar
  • 49 Sawaya R, Zuccarello M, Elkalliny M et al.. Postoperative venous thromboembolism and brain tumors: Part I. Clinical profile.  J Neurooncol. 1992;  14 119-125
    PubMedGoogle Scholar
  • 50 Pinedo H M. Thrombosis, prevalence and new evidence on current perceptions of risk.  Cancer Treat Rev. 2003;  29(S2) 3-5
    PubMedGoogle Scholar
  • 51 Goldhaber S Z, Dunn K, Gerhard-Herman M et al.. Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis.  Chest. 2002;  122 1933-1937
    CrossrefPubMedGoogle Scholar
  • 52 Iorio A, Agnelli G. Low-molecular-weight and unfractionated heparin for prevention of venous thromboembolism in neurosurgery: a meta-analysis.  Arch Intern Med. 2000;  160 2327-2332
    CrossrefPubMedGoogle Scholar
  • 53 Turpie A G, Eriksson B I, Bauer K A et al.. New pentasaccharides for the prophylaxis of venous thromboembolism: clinical studies.  Chest. 2003;  124 371S-378S
    CrossrefPubMedGoogle Scholar
  • 54 Lee A Y, Levine M N, Baker R I et al.. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer.  N Engl J Med. 2003;  349 146-153
    CrossrefPubMedGoogle Scholar
  • 55 Wells P S, Anderson D R, Rodger M et al.. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis.  N Engl J Med. 2003;  349 1227-1235
    Google Scholar
  • 56 Macdonald R L, Amidei C, Lin G et al.. Safety of perioperative subcutaneous heparin for prophylaxis of venous thromboembolism in patients undergoing craniotomy.  Neurosurgery. 1999;  45 245-251
    CrossrefPubMedGoogle Scholar
  • 57 Constantini S, Kanner A, Friedman A et al.. Safety of perioperative minidose heparin in patients undergoing brain tumor surgery: a prospective, randomized, double-blind study.  J Neurosurg. 2001;  94 918-921
    CrossrefPubMedGoogle Scholar
  • 58 Schiff D, DeAngelis L M. Therapy of venous thromboembolism in patients with brain metastases.  Cancer. 1994;  73 493-498
    CrossrefPubMedGoogle Scholar
  • 59 Levin J M, Schiff D, Loeffler J S et al.. Complications of therapy for venous thromboembolic disease in patients with brain tumors.  Neurology. 1993;  43 1111-1114
    CrossrefPubMedGoogle Scholar
  • 60 Gomes M P, Kaplan K L, Deitcher S R. Patients with inferior vena cava filters should receive chronic thromboprophylaxis.  Med Clin North Am. 2003;  87 1189-1203
    CrossrefPubMedGoogle Scholar
  • 61 Rubin H. Cancer cachexia: its correlations and causes.  Proc Natl Acad Sci U S A. 2003;  100 5384-5389
    CrossrefPubMedGoogle Scholar
  • 62 Chipkevitch E. Brain tumors and anorexia nervosa syndrome.  Brain Dev. 1994;  16 175-179
    CrossrefPubMedGoogle Scholar
  • 63 De Vile C J, Sufraz R, Lask B D et al.. Occult intracranial tumours masquerading as early onset anorexia nervosa.  BMJ. 1995;  311 1359-1360
    PubMedGoogle Scholar
  • 64 Trummer M, Eustacchio S, Unger F et al.. Right hemispheric frontal lesions as a cause for anorexia nervosa report of three cases.  Acta Neurochir (Wien). 2002;  144 797-801
    CrossrefPubMedGoogle Scholar
  • 65 Takahashi T, Kazama Y, Shimizu H et al.. Brain metastases of malignant melanoma showing unbalanced whole arm chromosomal translocations der (8; 14) (q10; q10) and der (11; 15) (q10; q10) in a Japanese patient.  Intern Med. 2001;  40 956-960
    CrossrefPubMedGoogle Scholar
  • 66 Laviano A, Meguid M M, Rossi-Fanelli F. Cancer anorexia: clinical implications, pathogenesis, and therapeutic strategies.  Lancet Oncol. 2003;  4 686-694
    CrossrefPubMedGoogle Scholar
  • 67 Comeau T B, Epstein J B, Migas C. Taste and smell dysfunction in patients receiving chemotherapy: a review of current knowledge.  Support Care Cancer. 2001;  9 575-580
    PubMedGoogle Scholar
  • 68 Fehm-Wolfsdorf G, Scheible E, Zenz H et al.. Taste thresholds in man are differentially influenced by hydrocortisone and dexamethasone.  Psychoneuroendocrinology. 1989;  14 433-440
    CrossrefPubMedGoogle Scholar
  • 69 Ishimaru T, Miwa T, Nomura M et al.. Reversible hyposmia caused by intracranial tumour.  J Laryngol Otol. 1999;  113 750-753
    PubMedGoogle Scholar
  • 70 Sagar S M, Thomas R J, Loverock L T et al.. Olfactory sensations produced by high-energy photon irradiation of the olfactory receptor mucosa in humans.  Int J Radiat Oncol Biol Phys. 1991;  20 771-776
    PubMedGoogle Scholar
  • 71 Vissink A, Burlage F R, Spijkervet F K et al.. Prevention and treatment of the consequences of head and neck radiotherapy.  Crit Rev Oral Biol Med. 2003;  14 213-225
    CrossrefPubMedGoogle Scholar
  • 72 Vissink A, Jansma J, Spijkervet F K et al.. Oral sequelae of head and neck radiotherapy.  Crit Rev Oral Biol Med. 2003;  14 199-212
    CrossrefPubMedGoogle Scholar
  • 73 Minami M, Endo T, Hirafuji M et al.. Pharmacological aspects of anticancer drug-induced emesis with emphasis on serotonin release and vagal nerve activity.  Pharmacol Ther. 2003;  99 149-165
    CrossrefPubMedGoogle Scholar
  • 74 Davis M P, Walsh D. Treatment of nausea and vomiting in advanced cancer.  Support Care Cancer. 2000;  8 444-452
    CrossrefPubMedGoogle Scholar
  • 75 Tremblay P B, Kaiser R, Sezer O et al.. Variations in the 5-hydroxytryptamine type 3B receptor gene as predictors of the efficacy of antiemetic treatment in cancer patients.  J Clin Oncol. 2003;  21 2147-2155
    CrossrefPubMedGoogle Scholar
  • 76 Henzi I, Walder B, Tramer M R. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review.  Anesth Analg. 2000;  90 186-194
    CrossrefPubMedGoogle Scholar
  • 77 Scalera G. Effects of conditioned food aversions on nutritional behavior in humans.  Nutr Neurosci. 2002;  5 159-188
    CrossrefPubMedGoogle Scholar
  • 78 Cerchietti L C, Navigante A H, Peluffo G D et al.. Effects of celecoxib, medroxyprogesterone, and dietary intervention on systemic syndromes in patients with advanced lung adenocarcinoma: a pilot study.  J Pain Symptom Manage. 2004;  27 85-95
    CrossrefPubMedGoogle Scholar
  • 79 Sato K, Onuma E, Yocum R C et al.. Treatment of malignancy-associated hypercalcemia and cachexia with humanized anti-parathyroid hormone-related protein antibody.  Semin Oncol. 2003;  30 167-173
    CrossrefPubMedGoogle Scholar
  • 80 Bruera E, Strasser F, Palmer J L et al.. Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study.  J Clin Oncol. 2003;  21 129-134
    CrossrefPubMedGoogle Scholar
  • 81 Potter J, Hami F, Bryan T et al.. Symptoms in 400 patients referred to palliative care services: prevalence and patterns.  Palliat Med. 2003;  17 310-314
    CrossrefPubMedGoogle Scholar
  • 82 Klaschik E, Nauck F, Ostgathe C. Constipation-modern laxative therapy.  Support Care Cancer. 2003;  11 679-685
    CrossrefPubMedGoogle Scholar
  • 83 Smith S. Evidence-based management of constipation in the oncology patient.  Eur J Oncol Nurs. 2001;  5 18-25
    CrossrefPubMedGoogle Scholar
  • 84 Kurz A, Sessler D I. Opioid-induced bowel dysfunction: pathophysiology and potential new therapies.  Drugs. 2003;  63 649-671
    CrossrefPubMedGoogle Scholar
  • 85 Meyers C A, Smith J A, Bezjak A et al.. Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial.  J Clin Oncol. 2004;  22 157-165
    CrossrefPubMedGoogle Scholar
  • 86 Poppelreuter M, Weis J, Kulz A K et al.. Cognitive dysfunction and subjective complaints of cancer patients. a cross-sectional study in a cancer rehabilitation centre.  Eur J Cancer. 2004;  40 43-49
    CrossrefPubMedGoogle Scholar
  • 87 Sharpe M, Strong V, Allen K et al.. Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs.  Br J Cancer. 2004;  90 314-320
    CrossrefPubMedGoogle Scholar
  • 88 Jacobsen P B, Donovan K A, Weitzner M A. Distinguishing fatigue and depression in patients with cancer.  Semin Clin Neuropsychiatry. 2003;  8 229-240
    PubMedGoogle Scholar
  • 89 Kelsen D P, Portenoy R K, Thaler H T et al.. Pain and depression in patients with newly diagnosed pancreas cancer.  J Clin Oncol. 1995;  13 748-755
    PubMedGoogle Scholar
  • 90 Fisch M J, Loehrer P J, Kristeller J et al.. Fluoxetine versus placebo in advanced cancer outpatients: a double-blinded trial of the Hoosier Oncology Group.  J Clin Oncol. 2003;  21 1937-1943
    CrossrefPubMedGoogle Scholar
  • 91 Atkinson A, Barsevick A, Cella D et al.. NCCN practice guidelines for cancer-related Fatigue.  Oncology. 2000;  14 151-161
    PubMedGoogle Scholar
  • 92 Escalante C P. Treatment of cancer-related fatigue: an update.  Support Care Cancer. 2003;  11 79-83
    PubMedGoogle Scholar
  • 93 Servaes P, van der Werf S, Prins J, Verhagen S, Bleijenberg G. Fatigue in disease-free cancer patients compared with fatigue in patients with chronic fatigue syndrome.  Support Care Cancer. 2001;  9 11-17
    CrossrefPubMedGoogle Scholar
  • 94 Pelletier G, Verhoef M J, Khatri N et al.. Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues.  J Neurooncol. 2002;  57 41-49
    CrossrefPubMedGoogle Scholar
  • 95 Stasi R, Abriani L, Beccaglia P et al.. Cancer-related fatigue-evolving concepts in evaluation and treatment.  Cancer. 2003;  98 1786-1801
    CrossrefPubMedGoogle Scholar
  • 96 Cella D, Lai J S, Chang C H et al.. Fatigue in cancer patients compared with fatigue in the general United States population.  Cancer. 2002;  94 528-538
    CrossrefPubMedGoogle Scholar
  • 97 Crawford J, Cella D, Cleeland C S et al.. Relationship between changes in hemoglobin level and quality of life during chemotherapy in anemic cancer patients receiving epoetin alfa therapy.  Cancer. 2002;  95 888-895
    CrossrefPubMedGoogle Scholar
  • 98 Villa P, Bigini P, Mennini T et al.. Erythropoietin selectively attenuates cytokine production and inflammation in cerebral ischemia by targeting neuronal apoptosis.  J Exp Med. 2003;  198 971-975
    CrossrefPubMedGoogle Scholar
  • 99 Olsen N V. Central nervous system frontiers for the use of erythropoietin.  Clin Infect Dis. 2003;  37(S4) S323-S330
    CrossrefPubMedGoogle Scholar
  • 100 Forsyth P A, Posner J B. Headaches in patients with brain tumors: a study of 111 patients.  Neurology. 1993;  43 1678-1683
    PubMedGoogle Scholar
  • 101 Jacox A, Carr D B, Payne R. New clinical-practice guidelines for the management of pain in patients with cancer.  N Engl J Med. 1994;  330 651-655
    CrossrefPubMedGoogle Scholar
  • 102 National Institutes of Health . Symptom management in cancer: pain, depression and fatigue: State-of-the-Science Conference Statement.  J Pain Palliat Care Pharmacother. 2003;  17 77-97
    PubMedGoogle Scholar
  • 103 Tuma R, DeAngelis L M. Altered mental status in patients with cancer.  Arch Neurol. 2000;  57 1727-1731
    CrossrefPubMedGoogle Scholar
  • 104 McCusker J, Cole M, Abrahamowicz M et al.. Environmental risk factors for delirium in hospitalized older people.  J Am Geriatr Soc. 2001;  49 1327-1334
    CrossrefPubMedGoogle Scholar
  • 105 Ljubisavljevic V, Kelly B. Risk factors for development of delirium among oncology patients.  Gen Hosp Psychiatry. 2003;  25 345-352
    CrossrefPubMedGoogle Scholar
  • 106 Caraceni A, Nanni O, Maltoni M et al.. Impact of delirium on the short term prognosis of advanced cancer patients.  Cancer. 2000;  89 1145-1149
    CrossrefPubMedGoogle Scholar
  • 107 Caraceni A, Grassi L. DELIRIUM: Acute Confusional States in Palliative Medicine. Oxford; Oxford University Press 2003
    Google Scholar
  • 108 Drislane F W. Nonconvulsive status epilepticus in patients with cancer.  Clin Neurol Neurosurg. 1994;  96 314-318
    CrossrefPubMedGoogle Scholar
  • 109 Towne A R, Waterhouse E J, Boggs J G et al.. Prevalence of nonconvulsive status epilepticus in comatose patients.  Neurology. 2000;  54 340-345
    CrossrefPubMedGoogle Scholar
  • 110 Primavera A, Audenino D, Cocito L. Ifosfamide encephalopathy and nonconvulsive status epilepticus.  Can J Neurol Sci. 2002;  29 180-183
    PubMedGoogle Scholar
  • 111 Martinez-Rodriguez J E, Barriga F J, Santamaria J et al.. Nonconvulsive status epilepticus associated with cephalosporins in patients with renal failure.  Am J Med. 2001;  111 115-119
    CrossrefPubMedGoogle Scholar
  • 112 Vento S, Cainelli F. Infections in patients with cancer undergoing chemotherapy: aetiology, prevention, and treatment.  Lancet Oncol. 2003;  4 595-604
    CrossrefPubMedGoogle Scholar
  • 113 Weimer L H. Medication-induced peripheral neuropathy.  Curr Neurol Neurosci Rep. 2003;  3 86-92
    PubMedGoogle Scholar
  • 114 Thomas R J. Neurotoxicity of antibacterial therapy.  South Med J. 1994;  87 869-874
    CrossrefPubMedGoogle Scholar
  • 115 Cunha B A. Antibiotic side effects.  Med Clin North Am. 2001;  85 149-185
    Google Scholar

Jerome B PosnerM.D. 

Department of Neurology, Memorial Sloan-Kettering Cancer Center

1275 York Avenue, New York, NY 10021

      >