Esmaeli Bita, Hortobagyi Gabriel N, Esteva Francisco J, Booser Daniel, Ahmadi M Amir, Rivera Edgardo, Arbuckle Rebecca, Delpassand Ebrahim, Guerra Laura, Valero Vicente
Ophthalmology Section, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Ophthalmology. 2002 Jun;109(6):1188-91. doi: 10.1016/s0161-6420(02)00989-2.
To compare the frequency of canalicular stenosis as a side effect of weekly versus every-3-weeks docetaxel in patients with metastatic breast cancer.
Retrospective nonrandomized comparative trial.
Eighteen patients enrolled in a phase II study of weekly docetaxel plus trastuzumab and 18 patients enrolled in a phase II study of every-3-weeks docetaxel plus doxorubicin were evaluated. Each patient underwent a comprehensive ophthalmologic examination, probing and irrigation of the nasolacrimal duct, and, in some instances, a nuclear lacrimal scan.
If epiphora (excessive tearing) was reported by the patient, its time of onset was documented. In patients with epiphora, presence or absence of canalicular stenosis was evaluated on the basis of the findings on probing and irrigation. The duration of treatment with docetaxel, the dose frequency, and the cumulative dose of docetaxel were recorded in each case.
Fourteen patients (77%) receiving weekly docetaxel plus trastuzumab had epiphora. Nine of these patients had significant anatomic narrowing of the canaliculi. Bicanalicular silicone intubation or dacryocystorhinostomy was recommended in all nine patients. Eight patients underwent surgery and experienced complete or near complete resolution of epiphora. Although two patients (11%) receiving every-3-weeks docetaxel plus doxorubicin reported transient symptoms of epiphora, neither patient was found to have narrowing of the canaliculi, and the epiphora was not severe enough to justify surgical intervention. The mean duration of docetaxel therapy for the patients in this study was 19 weeks. The mean cumulative dose of docetaxel was higher in patients with canalicular stenosis than in patients without this side effect.
Canalicular stenosis was more common in patients receiving weekly docetaxel than in those receiving every-3-weeks docetaxel for metastatic breast cancer. Bicanalicular silicone intubation early in the course of weekly docetaxel therapy should be considered, because this intervention can prevent complete closure of the canaliculi. Once complete or near complete stenosis of the canaliculi occurs, placement of a permanent Pyrex glass tube may become necessary to overcome the blockage of tear outflow.
比较转移性乳腺癌患者中，每周一次与每三周一次多西他赛治疗导致泪小管狭窄的发生率。
回顾性非随机对照试验。
对18例入组每周一次多西他赛联合曲妥珠单抗II期研究的患者以及18例入组每三周一次多西他赛联合阿霉素II期研究的患者进行评估。每位患者均接受了全面的眼科检查、鼻泪管探查及冲洗，部分患者还进行了泪道核素扫描。
若患者报告有溢泪（流泪过多），记录其发病时间。对于有溢泪的患者，根据探查及冲洗结果评估是否存在泪小管狭窄。记录每例患者多西他赛的治疗时长、给药频率及累积剂量。
14例（77%）接受每周一次多西他赛联合曲妥珠单抗治疗的患者出现溢泪。其中9例患者泪小管存在明显的解剖学狭窄。所有9例患者均建议行双泪小管硅胶插管术或泪囊鼻腔吻合术。8例患者接受了手术，溢泪症状完全或近乎完全缓解。虽然2例（11%）接受每三周一次多西他赛联合阿霉素治疗的患者报告有短暂溢泪症状，但均未发现泪小管狭窄，且溢泪症状不够严重，无需手术干预。本研究中患者多西他赛治疗的平均时长为19周。泪小管狭窄患者的多西他赛平均累积剂量高于无此副作用的患者。
转移性乳腺癌患者中，接受每周一次多西他赛治疗的患者比接受每三周一次多西他赛治疗的患者更易出现泪小管狭窄。在每周一次多西他赛治疗过程中早期应考虑行双泪小管硅胶插管术，因为该干预措施可防止泪小管完全闭合。一旦泪小管出现完全或近乎完全狭窄，可能需要放置永久性派热克斯玻璃管以克服泪液流出受阻的问题。
