Ifosfamide encephalopathy associated with chemotherapy for musculoskeletal sarcomas: incidence, severity, and risk factors.

Abstract

Ifosfamide encephalopathy is a central nervous system toxicity that occurs in patients treated with ifosfamide. Although it has been reported in European and American patients with various carcinomas, there have been no published reports regarding ifosfamide encephalopathy in Asian patients with bone and soft tissue sarcomas. We retrospectively examined the incidence, severity, and risk factors of ifosfamide encephalopathy in 61 Japanese patients with bone and soft tissue sarcomas at our institution. Ifosfamide encephalopathy occurred in 17 of 61 patients (31.2%) to whom ifosfamide was administered and in 29 of 214 ifosfamide treatment courses (13.6%). The most common symptoms of encephalopathy were "confusion," "somnolence," and "mood alteration - agitation." Severe encephalopathy occurred only in patients who received ifosfamide at doses >or=9 g/m(2). A history of cisplatin use was identified as a significant risk factor for the development of ifosfamide-induced encephalopathy. Because of the risk of severe encephalopathy, we conclude that patients who have previously received cisplatin or who receive ifosfamide at doses >or=9 g/m(2) require strict monitoring.