Banach Marta, Zygulska Aneta L, Krzemieniecki Krzysztof
Department of Neurology, Jagiellonian University, Krakow, Poland.
Department of Oncology, University Hospital, Krakow, Poland.
J Cancer Res Ther. 2018 Jul-Sep;14(5):1010-1013. doi: 10.4103/jcrt.JCRT_971_16.
Oxaliplatin-induced neurotoxicity is the single main dose-limiting factor in the treatment of colorectal cancer. The degree of neurotoxicity may be either acute and reversible or observed as cumulative and chronic peripheral nerve damage leading to peripheral neuropathy (PNP), walking difficulties, extremity hypersensitivity, tingling and numbness, and increased pain sensation.
The aim of this paper is to determine and compare the ratio of clinical versus subclinical PNP cases in colorectal patients who underwent oxaliplatin treatment.
Thirty-two colorectal cancer patients were enrolled in the study. Patients received chemotherapy either as folinic acid and 5-fluorouracil and oxaliplatin or capecitabine and oxaliplatin regimen. Electroneurophysiological tests were performed before the treatment and after the 4 cycle when the risk of peripheral nerve damage increases. All patients were subject to a standard neurological examination and a semi-structured questionnaire interview.
Following oxaliplatin treatment, 21 (66.6%) of all patients presented neurological symptoms and/or electrophysiologically measured signs of PNP; of those, 7 patients (33.4%) displayed only electrophysiological changes and the remaining 14 patients (66.6%) presented fully symptomatic PNP - 4 patients were new neuropathy cases while the other 10 patients were previously diagnosed with PNP and showed signs of further neuronal deterioration and progressing sensory and motor dysfunction.
Our study lays ground for further larger scale longitudinal studies on oxaliplatin neurotoxicity and its prevention. We believe that early diagnosis of oxaliplatin-induced neurotoxicity is essential in the prevention of irreversible nerve damage and should be prioritized when assessing and evaluating treatment so that adequate adjustment may be made.
奥沙利铂诱导的神经毒性是结直肠癌治疗中唯一主要的剂量限制因素。神经毒性的程度可能是急性且可逆的，也可能表现为累积性和慢性周围神经损伤，导致周围神经病变（PNP）、行走困难、肢体超敏反应、刺痛和麻木以及疼痛感觉增强。
本文旨在确定并比较接受奥沙利铂治疗的结直肠癌患者中临床PNP病例与亚临床PNP病例的比例。
32例结直肠癌患者纳入本研究。患者接受亚叶酸、5-氟尿嘧啶和奥沙利铂或卡培他滨和奥沙利铂方案的化疗。在治疗前和第4周期后进行神经电生理测试，此时周围神经损伤风险增加。所有患者均接受标准神经系统检查和半结构化问卷调查。
奥沙利铂治疗后，所有患者中有21例（66.6%）出现神经症状和/或电生理测量的PNP体征；其中，7例患者（33.4%）仅表现出电生理变化，其余14例患者（66.6%）出现完全有症状的PNP——4例为新发神经病变病例，另外10例患者先前被诊断为PNP，显示出进一步的神经元恶化以及感觉和运动功能障碍进展的迹象。
我们的研究为进一步开展关于奥沙利铂神经毒性及其预防的更大规模纵向研究奠定了基础。我们认为，奥沙利铂诱导的神经毒性的早期诊断对于预防不可逆神经损伤至关重要，在评估和评价治疗时应优先考虑，以便进行适当调整。
