Histology and platinum content of sensory ganglia and sural nerves in patients treated with cisplatin and carboplatin: an autopsy study

Cisplatin is a valuable antineoplastic drug which as a dose-limiting side-e ffect causes sensory neuropathy, and which therefore is often combined with less neurotoxic carboplatin. It has not been possible to reproduce cisplat in neuropathy in experimental animals, and the neurotoxic mechanism in man is disputed. We investigated post-mortem material from 12 patients and 15 c ontrol subjects. Half of the fibres with diameters of greater than or equal to 9 mu m, or more than 15% of all fibres (P < 0.02), had disappeared in t he sural nerves of patients, Signs of axonal regeneration were lacking, The dorsal root ganglia D12 and L2 of some but not of all patients contained n ecrotic neurons and nodules of Nageotte. The mean volume of the somata was reduced by 18% (P < 0.03). A relation between cumulated doses, treatment fr ee interval and changes in nerve or ganglia was not found. The platinum con tent was high in all tissues except in the spinal cord when the patient had died shortly after treatment, and it decreased with increasing interval, l east so in liver, sensory ganglia and sural nerves, The results support the hypothesis that cisplatin neuropathy is a neuro-neopathy rather than a dyi ng-back axonopathy.