Ther Clin Risk Manag. 2005 Dec;1(4):249-58.
Neurotoxicity is the most frequent dose-limiting toxicity of oxaliplatin. Acute sensory neurotoxicity manifests as rapid onset of cold-induced distal dysesthesia and/or paresthesia, sometimes accompanied by cold-dependent muscular contractions of the extremities or the jaw. The symptoms, often occurring during or shortly after infusion, are usually transient and mild. A cumulative sensory peripheral neuropathy may also develop with prolonged treatment with oxaliplatin, eventually causing superficial and deep sensory loss, sensory ataxia, and functional impairment. Studies have shown patients with acute sensory symptoms to display little or no axonal degeneration. The similarity of acute symptoms induced by oxaliplatin to those caused by several drugs or toxins acting on neuronal or muscular ion channels suggests that these symptoms may result from a specific interaction of oxaliplatin with voltage-gated sodium (Na(+)) channels. The current recommendations for the management of the acute and cumulative neurotoxicity from oxaliplatin include education about exposure to cold, dose modification, "stop and go", and use of neuromodulatory agents, in particular, intravenous calcium and magnesium infusion. Upon the approval of oxaliplatin-based regimens both for adjuvant and metastatic treatment of colon cancer, it is crucial to compile knowledge about the recognition and management of neurotoxicity from oxaliplatin.
神经毒性是奥沙利铂最常见的剂量限制毒性。急性感觉神经毒性表现为快速出现冷诱导的远端感觉异常和/或感觉迟钝，有时伴有四肢或下颌的冷依赖性肌肉收缩。这些症状通常在输注期间或之后不久发生，通常是短暂的和轻微的。随着奥沙利铂的长期治疗，还可能发生累积性感觉周围神经病，最终导致浅表和深部感觉丧失、感觉性共济失调和功能障碍。研究表明，有急性感觉症状的患者表现出很少或没有轴突退化。奥沙利铂引起的急性症状与作用于神经元或肌肉离子通道的几种药物或毒素引起的症状相似，这表明这些症状可能是奥沙利铂与电压门控钠（Na(+））通道的特定相互作用引起的。目前，奥沙利铂引起的急性和累积性神经毒性的管理建议包括关于接触冷的教育、剂量调整、“停走”策略以及使用神经调节药物，特别是静脉内钙和镁输注。奥沙利铂为基础的方案在结直肠癌辅助和转移性治疗中的批准，因此，编译关于奥沙利铂引起的神经毒性的识别和管理的知识至关重要。
