Stefansson Måns, Nygren Peter
a Department of Oncology , Mälarsjukhuset , Eskilstuna , Sweden.
b Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology , Uppsala University , Uppsala , Sweden.
Acta Oncol. 2016 Sep-Oct;55(9-10):1227-1235. doi: 10.1080/0284186X.2016.1197420. Epub 2016 Aug 23.
BACKGROUND: Oxaliplatin-induced peripheral neuropathy (OIPN) of acute and chronic type is well known, but long-term chronic type OIPN and its impact on quality of life (QoL) has not been extensively studied. Clinical experience indicates that oxaliplatin tolerance might vary with climate. MATERIAL AND METHODS: Patient-reported chronic type OIPN and QoL among patients treated with oxaliplatin added to a fluoropyrimidine (Folfox or Capox) in the adjuvant setting of colorectal cancer (CRC) were assessed in a single center cross-sectional study by using the EORTC QLQ-CIPN20 and QLQ-C30 questionnaires. Comparison was made to patients treated with a fluoropyrimidine (5-FU or capecitabine) alone during the same time period. RESULTS: Of 161 patients being disease-free 1-8 years after stop of treatment and invited, 84% participated; 65 treated with oxaliplatin and 71 with a fluoropyrimidine alone. Mean cumulative oxaliplatin dose was 567 mg/m (55% of planned dose). Oxaliplatin-treated patients reported statistically and clinically significant worse sensory as well as motor scale scores, dominated by symptoms from the feet. Severe tingling and numbness in toes/feet was reported by 38% and 37%, respectively, by oxaliplatin-treated patients compared with 8% for both by fluoropyrimidine alone patients (p < 0.001). Subgroup analyses indicated no impact of gender, age, regimen, time since stop of treatment or cumulated oxaliplatin dose for severity of the chronic type OIPN. The oxaliplatin compared with the fluoropyrimidine group reported worse QoL scores throughout all domains, with statistically and clinically significant differences for role and social function, nausea/loss of appetite and financial problems. CONCLUSIONS: Oxaliplatin added to a fluoropyrimidine for adjuvant treatment of CRC in a country with subarctic climate is associated with long-term, seemingly chronic, sensory neuropathy and impairment of QoL. This should be taken into account in clinical decision making on oxaliplatin treatment in the adjuvant setting.
背景:急性和慢性奥沙利铂诱导的周围神经病变(OIPN)已为人熟知,但长期慢性OIPN及其对生活质量(QoL)的影响尚未得到广泛研究。临床经验表明,奥沙利铂的耐受性可能因气候而异。 材料与方法:在一项单中心横断面研究中,使用欧洲癌症研究与治疗组织(EORTC)的QLQ-CIPN20和QLQ-C30问卷,评估在结直肠癌(CRC)辅助治疗中接受奥沙利铂联合氟嘧啶(Folfox或Capox)治疗的患者报告的慢性OIPN和QoL情况。与同期仅接受氟嘧啶(5-氟尿嘧啶或卡培他滨)治疗的患者进行比较。 结果:在161例治疗停止后1至8年无疾病且被邀请的患者中,84%参与了研究;65例接受奥沙利铂治疗,71例仅接受氟嘧啶治疗。奥沙利铂的平均累积剂量为567mg/m²(为计划剂量的55%)。接受奥沙利铂治疗的患者报告的感觉和运动量表评分在统计学和临床上均显著更差,主要症状来自足部。接受奥沙利铂治疗的患者中,分别有38%和37%报告脚趾/足部有严重刺痛和麻木,而仅接受氟嘧啶治疗的患者这两项症状的比例均为8%(p<0.001)。亚组分析表明,性别、年龄、治疗方案、治疗停止后的时间或奥沙利铂累积剂量对慢性OIPN的严重程度均无影响。与氟嘧啶组相比,奥沙利铂组在所有领域的QoL评分均更差,在角色和社会功能、恶心/食欲不振以及经济问题方面存在统计学和临床上的显著差异。 结论:在亚北极气候的国家,奥沙利铂联合氟嘧啶用于CRC辅助治疗与长期、看似慢性的感觉神经病变和QoL受损有关。在辅助治疗中使用奥沙利铂的临床决策中应考虑到这一点。
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