Clinical aspects of ifosfamide-induced encephalopathy

In the application of ifosfamide, one must be prepared for an ifosfamide-induced encephalopathy. The aim of our investigation was to determine the incidence of this side-effect and to describe its risk factors and the clinical management as well. Among 688 chemotherapy courses consisting of carboplatin and ifosfamide, we have observed an ifosfamide encephalopathy in 13 cases (1.89%) which was always associated with the risk factors alcohol anamnesis, hypalbuminemia, liver-or kidney dysfunction or a large tumor in the pelvis. Within the criteria of an intensive observation, the therapy consisted mainly of a forced diuresis in combination with a correction of the fluid and electrolyte balance. First experiences with the administration of methylene blue are reported. Using an ifosfamide dosage of 2 g/m(2) body surface area on day 1-3, and in consideration or exclusion of the above mentioned risk factors severe encephalopathies can be widely avoided.