Curtin University and Mount Hospital, Australia.
J Clin Oncol. 2013 Jun 10;31(17):2123-7. doi: 10.1200/JCO.2012.45.6574. Epub 2013 May 6.
To define the incidence and impact of tearing in patients receiving adjuvant docetaxel-based chemotherapy and assess for lacrimal duct obstruction (LDO) as a causative factor.
Consecutive patients with early breast cancer recommended for docetaxel-based chemotherapy with no prior ocular symptoms were included. Before and after completion of chemotherapy, patients underwent lacrimal drainage evaluation by computed tomographic dacrocystography (CT-DCG) and ophthalmic assessment. Eye symptoms were assessed at baseline, during, and after completion of chemotherapy.
Over a 22-month period, 100 patients were recruited. Asymptomatic LDO was present at baseline in 17% and 18% of patients, as assessed by ophthalmic review and CT-DCG, respectively. Overall, 86% of patients developed tearing, with no significant difference between those who did and did not have LDO (94% v 84%; P = .45). Blepharitis occurred in 37% and minor corneal epitheliopathy in 22% of patients, with neither condition predicting for the development of tearing. Impairment of visual activities was greatest after cycle one (70% of patients) but had decreased to < 5% by 4 months after treatment.
Tearing occurs in the majority of patients receiving adjuvant docetaxel-based chemotherapy regimens and occurred similarly in patients with and without LDO. There was poor concordance between CT-DCG and ophthalmic examination in the detection of LDO. Tearing and other eye symptoms impaired visual activities, but in nearly all patients, both symptoms and functional impairment were mild and had resolved by 4 months after chemotherapy. Our study demonstrates docetaxel-related tearing is not caused by LDO, and as such, evaluation or stenting of the duct is not considered necessary.
定义接受辅助多西紫杉醇化疗的患者中撕裂的发生率和影响，并评估泪道阻塞（LDO）是否为致病因素。
纳入了连续患有早期乳腺癌且推荐接受多西紫杉醇化疗且无眼部症状的患者。在完成化疗前后，患者接受泪液引流评估，包括计算机断层泪囊造影（CT-DCG）和眼科评估。在基线、化疗期间和化疗结束后评估眼部症状。
在 22 个月的时间里，共招募了 100 名患者。通过眼科检查和 CT-DCG 评估，分别有 17%和 18%的患者在基线时无症状性 LDO。总体而言，86%的患者出现流泪，但 LDO 患者和无 LDO 患者之间无显著差异（94%比 84%；P=.45）。37%的患者发生了睑缘炎，22%的患者出现了轻微的角膜上皮病变，但这两种情况均未预测流泪的发生。在第一个周期后，视觉活动受损最为严重（70%的患者），但在治疗后 4 个月降至<5%。
在接受辅助多西紫杉醇化疗方案的患者中，大多数患者会出现流泪，并且有和无 LDO 的患者流泪发生率相似。CT-DCG 和眼科检查在检测 LDO 方面的一致性较差。流泪和其他眼部症状会影响视觉活动，但在几乎所有患者中，症状和功能障碍都较轻，并且在化疗后 4 个月内已得到缓解。我们的研究表明，多西紫杉醇相关的流泪不是由 LDO 引起的，因此，不需要对导管进行评估或支架置入。
