Tsalic Medy, Gilboa Michael, Visel Bela, Miller Benjamin, Haim Nissim
Department of Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Med Oncol. 2006;23(1):57-61. doi: 10.1385/MO:23:1:57.
Epiphora due to canalicular stenosis is a recently described side effect of weekly docetaxel. We prospectively evaluated the incidence of this complication and other ocular manifestations in patients treated at our medical center.
Twenty-one consecutive patients (breast cancer: 14; metastatic non-small cell lung cancer: 6; metastatic nasopharyngeal carcinoma: 1) (female/male: 14/7; age range: 34-78 yr) were treated with weekly docetaxel (35 mg/m2/wk iv for 6 wk, cycles repeated every 49 d). A standard questionnaire regarding epiphora was completed before each dose of docetaxel. Patients who complained of excessive tearing underwent a thorough ophthalmologic evaluation before receiving the next dose.
Epiphora due to stenosis of the lacrimal puncti and canaliculi developed in seven (33%) patients following a cumulative dose of 208-645 mg/m2 (median: 400 mg/m2). Two patients developed complete canalicular stenosis requiring surgery. Epiphora was accompanied by madarosis and ectodermalization of the palpebral and bulbar conjunctiva, complete in five patients. Treatment was discontinued due to epiphora in two (10%) patients. After a median follow-up of 11 mo, four patients still had epiphora.
Epiphora due to canalicular stenosis is a frequent complication of weekly docetaxel and might be dose limiting. Irreversible damage requiring surgical intervention may develop despite close monitoring.
泪小管狭窄所致溢泪是近期报道的每周使用多西他赛的一种副作用。我们前瞻性评估了在本医疗中心接受治疗的患者中这种并发症及其他眼部表现的发生率。
连续21例患者（乳腺癌：14例；转移性非小细胞肺癌：6例；转移性鼻咽癌：1例）（女性/男性：14/7；年龄范围：34 - 78岁）接受每周一次的多西他赛治疗（35 mg/m²/周，静脉注射，共6周，每49天重复一个周期）。在每次多西他赛给药前完成一份关于溢泪的标准问卷。主诉流泪过多的患者在接受下一剂药物前接受全面的眼科评估。
在累积剂量达208 - 645 mg/m²（中位数：400 mg/m²）后，7例（33%）患者出现泪点和泪小管狭窄所致溢泪。2例患者出现完全性泪小管狭窄，需要手术治疗。溢泪伴有睫毛脱落以及睑结膜和球结膜的外胚层化，5例患者表现完全。2例（10%）患者因溢泪而停药。中位随访11个月后，4例患者仍有溢泪症状。
泪小管狭窄所致溢泪是每周使用多西他赛常见的并发症，可能会限制剂量。尽管密切监测，仍可能发生需要手术干预的不可逆损伤。
