Nudelman Kelly N H, McDonald Brenna C, Wang Yang, Smith Dori J, West John D, O'Neill Darren P, Zanville Noah R, Champion Victoria L, Schneider Bryan P, Saykin Andrew J
Kelly N.H. Nudelman, Brenna C. McDonald, Yang Wang, Dori J. Smith, John D. West, Darren P. O'Neill, Victoria L. Champion, Bryan P. Schneider, and Andrew J. Saykin, Indiana University School of Medicine; Noah R. Zanville and Victoria L. Champion, Indiana University School of Nursing, Indianapolis, IN; and Yang Wang, Medical College of Wisconsin, Milwaukee, WI.
J Clin Oncol. 2016 Mar 1;34(7):677-83. doi: 10.1200/JCO.2015.62.1276. Epub 2015 Nov 2.
To investigate the longitudinal relationship between chemotherapy-induced peripheral neuropathy (CIPN) symptoms (sx) and brain perfusion changes in patients with breast cancer. Interaction of CIPN-sx perfusion effects with known chemotherapy-associated gray matter density decrease was also assessed to elucidate the relationship between CIPN and previously reported cancer treatment-related brain structural changes.
Patients with breast cancer treated with (n = 24) or without (n = 23) chemotherapy underwent clinical examination and brain magnetic resonance imaging at the following three time points: before treatment (baseline), 1 month after treatment completion, and 1 year after the 1-month assessment. CIPN-sx were evaluated with the self-reported Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity four-item sensory-specific scale. Perfusion and gray matter density were assessed using voxel-based pulsed arterial spin labeling and morphometric analyses and tested for association with CIPN-sx in the patients who received chemotherapy.
Patients who received chemotherapy reported significantly increased CIPN-sx from baseline to 1 month, with partial recovery by 1 year (P < .001). CIPN-sx increase from baseline to 1 month was significantly greater for patients who received chemotherapy compared with those who did not (P = .001). At 1 month, neuroimaging showed that for the group that received chemotherapy, CIPN-sx were positively associated with cerebral perfusion in the right superior frontal gyrus and cingulate gyrus, regions associated with pain processing (P < .001). Longitudinal magnetic resonance imaging analysis in the group receiving chemotherapy indicated that CIPN-sx and associated perfusion changes from baseline to 1 month were also positively correlated with gray matter density change (P < .005).
Peripheral neuropathy symptoms after systemic chemotherapy for breast cancer are associated with changes in cerebral perfusion and gray matter. The specific mechanisms warrant further investigation given the potential diagnostic and therapeutic implications.
研究乳腺癌患者化疗诱导的周围神经病变（CIPN）症状与脑灌注变化之间的纵向关系。还评估了CIPN症状灌注效应与已知化疗相关灰质密度降低之间的相互作用，以阐明CIPN与先前报道的癌症治疗相关脑结构变化之间的关系。
接受（n = 24）或未接受（n = 23）化疗的乳腺癌患者在以下三个时间点接受临床检查和脑磁共振成像：治疗前（基线）、治疗完成后1个月、1个月评估后1年。使用自我报告的癌症治疗功能评估/妇科肿瘤学组神经毒性四项感觉特异性量表评估CIPN症状。使用基于体素的脉冲动脉自旋标记和形态学分析评估灌注和灰质密度，并对接受化疗的患者测试其与CIPN症状的相关性。
接受化疗的患者报告CIPN症状从基线到1个月显著增加，到1年时部分恢复（P <.001）。与未接受化疗的患者相比，接受化疗的患者从基线到1个月的CIPN症状增加显著更大（P =.001）。在1个月时，神经影像学显示，对于接受化疗的组，CIPN症状与右侧额上回和扣带回的脑灌注呈正相关，这些区域与疼痛处理有关（P <.001）。接受化疗组的纵向磁共振成像分析表明，从基线到1个月的CIPN症状和相关灌注变化也与灰质密度变化呈正相关（P <.005）。
乳腺癌全身化疗后的周围神经病变症状与脑灌注和灰质变化有关。鉴于其潜在的诊断和治疗意义，具体机制值得进一步研究。
