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紫杉烷类药物引起的周围神经病具有良好的长期预后:1 至 13 年的评估。

Taxane-induced peripheral neuropathy has good long-term prognosis: a 1- to 13-year evaluation.

机构信息

AP-HP, Service de Physiologie Clinique, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010, Paris, France.

出版信息

J Neurol. 2012 Sep;259(9):1936-43. doi: 10.1007/s00415-012-6442-5. Epub 2012 Feb 17.

Abstract

Taxane-induced neuropathy is a frequent complication, in particular in women with breast cancer. The incidence can be variable and ranges from 11 to 87%, depending on the taxane used and identified risk factors, such as cumulative dose, additional neurotoxic chemotherapy agents and previous nerve fragility. However, little is known about long-term outcome and interference with daily life activities. The objective of this study was to assess clinical and electrophysiological neurological evaluation (ENMG) in a cohort of patients, 1-13 years (median 3 years) after the end of the last cure. Sixty-nine women were enrolled in the lymphology unit of Cognacq-Jay's Hospital. They were 58 ± 9 years old (mean age ± SD) and had been treated by docetexel (n = 56), paclitaxel (n = 10) or both (n = 3), 1-13 years before. Sensory neuropathy occurred in 64% and totally disappeared within months for only 14% after cessation of treatment. However, if symptoms were still present at the time of examination, they were considered as minor by almost all patients, with no interference with daily life activities (grade 2 CTCAE v.3.0). ENMG was accepted by 14 patients; it was normal in 7, and showed sensory axonal neuropathy in 5 and sensory-motor neuropathy in 2. The incidence of taxane-induced neuropathy is high, more frequent with paclitaxel than docetaxel, and is characterized by minor or moderate axonal sensory polyneuropathy. When persistent, it is extremely well tolerated by the patient. When clinical motor signs occur, the patient should be referred to a neurologist.

摘要

紫杉烷类药物引起的周围神经病是一种常见的并发症,尤其是在乳腺癌女性中。其发生率可能有所不同,范围在 11%至 87%之间,取决于所用的紫杉烷类药物和已确定的风险因素,如累积剂量、其他神经毒性化疗药物以及先前的神经脆弱性。然而,关于长期结果及其对日常生活活动的干扰知之甚少。本研究的目的是评估最后一次治疗结束后 1 至 13 年(中位数为 3 年)的患者队列的临床和电生理学神经评估(ENMG)。69 名女性被纳入科尼亚克-雅伊医院的淋巴学单位。她们的年龄为 58 ± 9 岁(平均年龄 ± 标准差),曾接受多西紫杉醇(n = 56)、紫杉醇(n = 10)或两者联合治疗(n = 3),治疗时间在 1 至 13 年前。感觉神经病变的发生率为 64%,仅 14%的患者在治疗停止后数月内完全消失。然而,如果症状在检查时仍然存在,几乎所有患者都认为症状轻微,不会对日常生活活动造成干扰(CTCAE v.3.0 分级 2)。14 名患者接受了 ENMG 检查;其中 7 名正常,5 名显示感觉轴索性神经病,2 名显示感觉运动神经病。紫杉烷类药物引起的周围神经病的发生率较高,紫杉醇比多西紫杉醇更常见,表现为轻微或中度的轴索性感觉多发性神经病。当持续存在时,患者的耐受性极好。当出现临床运动体征时,应将患者转介给神经科医生。

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