Esmaeli Bita, Hidaji Lillie, Adinin Rosnie B, Faustina Misha, Coats Carol, Arbuckle Rebecca, Rivera Edgardo, Valero Vicente, Tu Shi-Ming, Ahmadi M Amir
Section of Ophthalmology, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2003 Aug 1;98(3):504-7. doi: 10.1002/cncr.11527.
The current study was conducted to report the severity and management of canalicular and nasolacrimal duct stenosis as a side effect of docetaxel therapy and to report the outcomes of surgical intervention for this condition.
The records of 148 patients with epiphora associated with docetaxel therapy who were evaluated at the Ophthalmology Service at The University of Texas M. D. Anderson Cancer Center were reviewed. The frequency of docetaxel administration, the dose intensity, the cumulative dose of docetaxel, and any concomitant chemotherapeutic agents were recorded. Each patient underwent an ophthalmologic examination and in-office probing and irrigation. The patients either were treated with topical steroids or offered a surgical procedure for canalicular stenosis- (silicone intubation, dacryocystorhinostomy [DCR] with the placement of silicone tubes, or DCR with the placement of Pyrex glass tubes), depending on the severity of the canalicular stenosis.
Docetaxel was given weekly in 71 patients, every 2 weeks in 5 patients, and every 3 weeks in 72 patients. Thirty patients (59 eyes) who received weekly docetaxel underwent surgery to correct epiphora. Twenty-three patients (39 eyes) were treated with temporary silicone tube placement, 9 patients (13 eyes) were treated with DCR with temporary silicone tube placement, and 4 patients (7 eyes) were treated with DCR with permanent Pyrex glass tube placement. Twenty-nine of the 30 patients who underwent surgery reported improvement or total resolution of epiphora after the procedure. Ten additional patients (20 eyes) who received weekly docetaxel had complete closure of their canaliculi but elected not to undergo surgery. Of special note were two patients who received weekly docetaxel in the neoadjuvant setting and developed complete closure of the canaliculi. Of the patients who received docetaxel every 2 or 3 weeks, only 3 required a surgical intervention to correct epiphora; none required Pyrex glass tube placement.
Canalicular and nasolacrimal duct obstruction is a common side effect of weekly docetaxel therapy and can occur even when this drug is used in the neoadjuvant setting. The results of the current study indicate that early temporary silicone intubation in symptomatic patients receiving weekly docetaxel can prevent further closure of the lacrimal drainage apparatus and obviate more involved surgical interventions and permanent Pyrex glass tube placement. Cancer 2003;98:504-7.
本研究旨在报告多西他赛治疗引起的泪小管及鼻泪管狭窄的严重程度及处理方法，并报告针对该病症手术干预的结果。
回顾了得克萨斯大学MD安德森癌症中心眼科对148例因多西他赛治疗出现溢泪症状患者的记录。记录多西他赛的给药频率、剂量强度、累积剂量以及任何同时使用的化疗药物。每位患者均接受眼科检查及门诊探通和冲洗。根据泪小管狭窄的严重程度，患者要么接受局部类固醇治疗，要么接受针对泪小管狭窄的手术治疗（硅胶管植入、硅胶管植入的泪囊鼻腔吻合术[DCR]或派热克斯玻璃管植入的DCR）。
71例患者每周接受多西他赛治疗，5例每2周接受一次，72例每3周接受一次。30例（59眼）每周接受多西他赛治疗的患者接受了手术以纠正溢泪。23例（39眼）接受了临时硅胶管植入治疗，9例（13眼）接受了硅胶管植入的DCR治疗，4例（7眼）接受了派热克斯玻璃管植入的DCR治疗。接受手术的30例患者中有29例术后报告溢泪症状改善或完全缓解。另外10例（20眼）每周接受多西他赛治疗的患者泪小管完全闭塞，但选择不接受手术。特别值得注意的是2例在新辅助治疗中每周接受多西他赛治疗并出现泪小管完全闭塞的患者。在每2周或每3周接受多西他赛治疗的患者中，只有3例需要手术干预来纠正溢泪；无人需要植入派热克斯玻璃管。
泪小管及鼻泪管阻塞是每周多西他赛治疗的常见副作用，即使在新辅助治疗中使用该药物时也可能发生。本研究结果表明，对于接受每周多西他赛治疗的有症状患者，早期进行临时硅胶管植入可防止泪道引流装置进一步闭塞，并避免更复杂的手术干预及永久性派热克斯玻璃管植入。《癌症》2003年；98：504 - 507。
