Pignata Sandro, De Placido Sabino, Biamonte Rosalbino, Scambia Giovanni, Di Vagno Giovanni, Colucci Giuseppe, Febbraro Antonio, Marinaccio Marco, Lombardi Alessandra Vernaglia, Manzione Luigi, Cartenì Giacomo, Nardi Mario, Danese Saverio, Valerio Maria Rosaria, de Matteis Andrea, Massidda Bruno, Gasparini Giampietro, Di Maio Massimo, Pisano Carmela, Perrone Francesco
Medical Oncology B, National Cancer Institute, Naples, Italy.
BMC Cancer. 2006 Jan 7;6:5. doi: 10.1186/1471-2407-6-5.
Carboplatin/paclitaxel is the chemotherapy of choice for advanced ovarian cancer, both in first line and in platinum-sensitive recurrence. Although a significant proportion of patients have some neurotoxicity during treatment, the long-term outcome of chemotherapy-induced neuropathy has been scantly studied. We retrospectively assessed the prevalence of residual neuropathy in a cohort of patients in clinical remission after first-line carboplatin/paclitaxel for advanced ovarian cancer.
120 patients have been included in this study (101 participating in a multicentre phase III trial evaluating the efficacy of consolidation treatment with topotecan, and 19 treated at the National Cancer Institute of Naples after the end of the trial). All patients received carboplatin (AUC 5) plus paclitaxel (175 mg/m2) every 3 weeks for 6 cycles, completing treatment between 1998 and 2003. Data were collected between May and September 2004. Residual sensory and motor neurotoxicity were coded according to the National Cancer Institute--Common Toxicity Criteria.
55 patients (46%) did not experience any grade of neurological toxicity during chemotherapy and of these none had signs of neuropathy during follow-up. The other 65 patients (54%) had chemotherapy-induced neurotoxicity during treatment and follow-up data are available for 60 of them. Fourteen out of 60 patients (23%) referred residual neuropathy at the most recent follow-up visit, after a median follow up of 18 months (range, 7-58 months): 12 patients had grade 1 and 2 patients grade 2 peripheral sensory neuropathy; 3 patients also had grade 1 motor neuropathy. The remaining 46/60 patients (77%) had no residual neuropathy at the moment of interview: recovery from neurotoxicity had occurred in the first 2 months after the end of chemotherapy in 22 (37%), between 2 and 6 months in 15 (25%), or after more than 6 months in 9 patients (15%). Considering all 120 treated patients, there was a 15% probability of persistent neurological toxicity 6 months after the end of chemotherapy.
A significant proportion of patients with advanced ovarian cancer treated with first-line carboplatin/paclitaxel suffer long-term residual neuropathy. This issue should be carefully taken into account before considering re-treatment with the same agents in sensitive recurrent disease.
卡铂/紫杉醇是晚期卵巢癌一线治疗及铂敏感复发治疗的首选化疗方案。尽管相当一部分患者在治疗期间会出现一些神经毒性，但化疗引起的神经病变的长期转归鲜有研究。我们回顾性评估了一组晚期卵巢癌患者在一线接受卡铂/紫杉醇治疗后临床缓解但仍存在神经病变的情况。
本研究纳入了120例患者（101例参与了一项评估拓扑替康巩固治疗疗效的多中心III期试验，19例在试验结束后于那不勒斯国家癌症研究所接受治疗）。所有患者每3周接受一次卡铂（AUC 5）加紫杉醇（175 mg/m²）治疗，共6个周期，治疗时间为1998年至2003年。数据收集于2004年5月至9月。根据美国国立癌症研究所通用毒性标准对残留的感觉和运动神经毒性进行编码。
55例患者（46%）在化疗期间未出现任何程度的神经毒性，其中在随访期间均无神经病变迹象。另外65例患者（54%）在治疗期间出现了化疗引起的神经毒性，其中60例有随访数据。60例患者中有14例（23%）在中位随访18个月（范围7 - 58个月）后的最近一次随访中提及仍存在神经病变：12例患者为1级和2级周围感觉神经病变，2例患者为2级；3例患者还伴有1级运动神经病变。其余46/60例患者（77%）在访谈时无残留神经病变：22例（37%）在化疗结束后的前2个月内神经毒性已恢复，15例（25%）在2至6个月内恢复，9例患者（15%）在6个月后恢复。在所有120例接受治疗的患者中，化疗结束后6个月仍存在持续性神经毒性的概率为15%。
相当一部分接受一线卡铂/紫杉醇治疗的晚期卵巢癌患者会出现长期残留神经病变。在考虑对敏感复发疾病再次使用相同药物治疗之前，应仔细考虑这一问题。
