Periferik Nöropati

Yazarlar

Özet

Periferik nöropati kanser hastalarında kronik hastalıklara bağlı, paraneoplastik olarak veya kemoterapi ilişkili olarak en çok karşımıza çıkan semptomlardan biridir. Paraneoplastik nöropati etyolojisinde daha çok antikorlar rol oynarken; kemoterapiye bağlı nöropatide klinik kullanımımızda önemli bir yeri olan taksan ve platin bazlı tedaviler daha çok etkendir. Hastalar genel olarak el ve ayaklarda uyuşma, karıncalanma ,soğuk hassasiyeti, yanma, ağrı gibi semptomlardan yakınırlar. Bazı hastalar için bu yakınmalar hayat kalitesini olumsuz yönde etkiler ve tedaviye devam edememe ile sonuçlanabilir. Teşhis için elektrodiyagnostik testler kullanılabilmektedir. Periferik nöropati tedavisinde araştırılan pek çok uygulama ve etken madde olmasına rağmen gösterilmiş yararları sınırlıdır. Bu konuda ilerleyen süreçte daha kapsamlı çalışmalara ihtiyaç duyulmaktadır. Bizler de hastalarımızda, nöropatiye sebep olabilecek olası diğer etkenleri önlemek için gerekli tedbirleri almalı ve aktif tedavi aldıkları süreç boyunca her kemoterapi vizitinde nöropatik yakınmalar yönünden sorgulamalıyız.

Peripheral neuropathy is one of the most common symptoms in cancer patients due to chronic diseases, paraneoplastic or chemotherapy related. While antibodies play a role in the etiology of paraneoplastic neuropathy. Taxane and platinum-based therapies, which have an important place in our clinical use, are more effective in chemotherapy-related neuropathy. Patients generally complain of symptoms such as numbness, tingling, cold sensitivity, burning and pain in the hands and feet. For some patients, these complaints negatively affect the quality of life and may result in discontinuation of treatment. Electrodiagnostic tests can be used for diagnosis. Although there are many applications and active substances being investigated in the treatment of peripheral neuropathy, their demonstrated benefits are limited. More comprehensive studies are needed in this regard in the future. We should take the necessary precautions to prevent other possible factors that may cause neuropathy in our patients and question them for neuropathic complaints at each chemotherapy visit during the active treatment period.

Referanslar

Hughes R. Investigation of peripheral neuropathy. BMJ. 2010 Nov 5;341:c6100. doi: 10.1136/bmj.c6100. PMID: 21056962.

England JD, Gronseth GS, Franklin G, Carter GT, Kinsella LJ, Cohen JA, Asbury AK, Szigeti K, Lupski JR, Latov N, Lewis RA, Low PA, Fisher MA, Herrmann D, Howard JF, Lauria G, Miller RG, Polydefkis M, Sumner AJ; American Academy of Neurology; American Association of Neuromuscular and Electrodiagnostic Medicine; American Academy of Physical Medicine and Rehabilitation. Evaluation of distal symmetric polyneuropathy: the role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Muscle Nerve. 2009 Jan;39(1):106-15. doi: 10.1002/mus.21227. PMID: 19086069.

Hanewinckel R, Ikram MA, Van Doorn PA. Peripheral neuropathies. Handb Clin Neurol. 2016;138:263-82. doi: 10.1016/B978-0-12-802973-2.00015-X. PMID: 27637963.

Graus F, Delattre JY, Antoine JC, Dalmau J, Giometto B, Grisold W, Honnorat J, Smitt PS, Vedeler Ch, Verschuuren JJ, Vincent A, Voltz R. Recommended diagnostic criteria for paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry. 2004 Aug;75(8):1135-40. doi: 10.1136/jnnp.2003.034447. PMID: 15258215; PMCID: PMC1739186.

Graus F, Vogrig A, Muñiz-Castrillo S, Antoine JG, Desestret V, Dubey D, Giometto B, Irani SR, Joubert B, Leypoldt F, McKeon A, Prüss H, Psimaras D, Thomas L, Titulaer MJ, Vedeler CA, Verschuuren JJ, Dalmau J, Honnorat J. Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes. Neurol Neuroimmunol Neuroinflamm. 2021 May 18;8(4):e1014. doi: 10.1212/NXI.0000000000001014. PMID: 34006622; PMCID: PMC8237398.

Sertny M, Currie GL, Sena ES, et al. İncidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Pain 2014;155(12).2461-70

Flatters SJL, Dougherty PM, Colvin LA. Clinical and preclinical perspectives on Chemotherapy-Induced Peripheral Neuropathy (CIPN): a narrative review. Br J Anaesth. 2017 Oct 1;119(4):737-749. doi: 10.1093/bja/aex229. PMID: 29121279.

Chhibber A, Mefford J, Stahl EA, Pendergrass SA, Baldwin RM, Owzar K, Li M, Winer EP, Hudis CA, Zembutsu H, Kubo M, Nakamura Y, McLeod HL, Ratain MJ, Shulman LN, Ritchie MD, Plenge RM, Witte JS, Kroetz DL. Polygenic inheritance of paclitaxel-induced sensory peripheral neuropathy driven by axon outgrowth gene sets in CALGB 40101 (Alliance). Pharmacogenomics J. 2014 Aug;14(4):336-42. doi: 10.1038/tpj.2014.2. Epub 2014 Feb 11. PMID: 24513692; PMCID: PMC4111770.

Wheeler HE, Gamazon ER, Wing C, Njiaju UO, Njoku C, Baldwin RM, Owzar K, Jiang C, Watson D, Shterev I, Kubo M, Zembutsu H, Winer EP, Hudis CA, Shulman LN, Nakamura Y, Ratain MJ, Kroetz DL; Cancer and Leukemia Group B; Cox NJ, Dolan ME. Integration of cell line and clinical trial genome-wide analyses supports a polygenic architecture of Paclitaxel-induced sensory peripheral neuropathy. Clin Cancer Res. 2013 Jan 15;19(2):491-9. doi: 10.1158/1078-0432.CCR-12-2618. Epub 2012 Nov 30. PMID: 23204130; PMCID: PMC3549006.

Corthals SL, Kuiper R, Johnson DC, Sonneveld P, Hajek R, van der Holt B, Magrangeas F, Goldschmidt H, Morgan GJ, Avet-Loiseau H. Genetic factors underlying the risk of bortezomib induced peripheral neuropathy in multiple myeloma patients. Haematologica. 2011 Nov;96(11):1728-32. doi: 10.3324/haematol.2011.041434. Epub 2011 Jul 26. PMID: 21791469; PMCID: PMC3208695.

Baldwin RM, Owzar K, Zembutsu H, Chhibber A, Kubo M, Jiang C, Watson D, Eclov RJ, Mefford J, McLeod HL, Friedman PN, Hudis CA, Winer EP, Jorgenson EM, Witte JS, Shulman LN, Nakamura Y, Ratain MJ, Kroetz DL. A genome-wide association study identifies novel loci for paclitaxel-induced sensory peripheral neuropathy in CALGB 40101. Clin Cancer Res. 2012 Sep 15;18(18):5099-109. doi: 10.1158/1078-0432.CCR-12-1590. Epub 2012 Jul 27. PMID: 22843789; PMCID: PMC3445665.

Broyl A, Corthals SL, Jongen JL, van der Holt B, Kuiper R, de Knegt Y, van Duin M, el Jarari L, Bertsch U, Lokhorst HM, Durie BG, Goldschmidt H, Sonneveld P. Mechanisms of peripheral neuropathy associated with bortezomib and vincristine in patients with newly diagnosed multiple myeloma: a prospective analysis of data from the HOVON-65/GMMG-HD4 trial. Lancet Oncol. 2010 Nov;11(11):1057-65. doi: 10.1016/S1470-2045(10)70206-0. Epub 2010 Sep 21. PMID: 20864405.

Pachman DR, Qin R, Seisler DK, Smith EM, Beutler AS, Ta LE, Lafky JM, Wagner-Johnston ND, Ruddy KJ, Dakhil S, Staff NP, Grothey A, Loprinzi CL. Clinical Course of Oxaliplatin-Induced Neuropathy: Results From the Randomized Phase III Trial N08CB (Alliance). J Clin Oncol. 2015 Oct 20;33(30):3416-22. doi: 10.1200/JCO.2014.58.8533. Epub 2015 Aug 17. PMID: 26282635; PMCID: PMC4606060.

Paice JA, Mulvey M, Bennett M, et al. AAPT Diagnostic Criteria for Chronic Cancer Pain Conditions. J Pain 2017; 18:233

Loprinzi CL, Lacchetti C, Bleeker J, Cavaletti G, Chauhan C, Hertz DL, Kelley MR, Lavino A, Lustberg MB, Paice JA, Schneider BP, Lavoie Smith EM, Smith ML, Smith TJ, Wagner-Johnston N, Hershman DL. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. J Clin Oncol. 2020 Oct 1;38(28):3325-3348. doi: 10.1200/JCO.20.01399. Epub 2020 Jul 14. PMID: 32663120.

Beijers AJM, Bonhof CS, Mols F, Ophorst J, de Vos-Geelen J, Jacobs EMG, van de Poll-Franse LV, Vreugdenhil G. Multicenter randomized controlled trial to evaluate the efficacy and tolerability of frozen gloves for the prevention of chemotherapy-induced peripheral neuropathy. Ann Oncol. 2020 Jan;31(1):131-136. doi: 10.1016/j.annonc.2019.09.006. PMID: 31912787.

Accordino MK, Lee S, Leu CS, Levin B, Trivedi MS, Crew KD, Kalinsky K, Raghunathan R, Faheem K, Harden E, Taboada A, de Oliveira BD, Larson E, Franks L, Honan E, Law C, Hershman DL. Randomized adaptive selection trial of cryotherapy, compression therapy, and placebo to prevent taxane-induced peripheral neuropathy in patients with breast cancer. Breast Cancer Res Treat. 2024 Feb;204(1):49-59. doi: 10.1007/s10549-023-07172-y. Epub 2023 Dec 7. PMID: 38060077; PMCID: PMC10840989.

Kleckner IR, Kamen C, Gewandter JS, Mohile NA, Heckler CE, Culakova E, Fung C, Janelsins MC, Asare M, Lin PJ, Reddy PS, Giguere J, Berenberg J, Kesler SR, Mustian KM. Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial. Support Care Cancer. 2018 Apr;26(4):1019-1028. doi: 10.1007/s00520-017-4013-0. Epub 2017 Dec 14. PMID: 29243164; PMCID: PMC5823751.

Guo Y, Jones D, Palmer JL, Forman A, Dakhil SR, Velasco MR, et al. Oral alpha-lipoic acid to prevent chemotherapy-induced peripheral neuropathy: a randomized, double-blind, placebo-controlled trial. Support Care Cancer. 2014;22(5):1223–31.

Howells LM, Iwuji COO, Irving GRB, Barber S, Walter H, Sidat Z, et al. Curcumin combined with FOLFOX chemotherapy is safe and tolerable in patients with metastatic colorectal cancer in a randomized phase IIa trial. J Nutr. 2019;149(7):1133–9

Pace A, Savarese A, Picardo M, Maresca V, Pacetti U, Del Monte G, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol. 2003;21(5):927–31.

Pace A, Nisticò C, Cuppone F, Bria E, Galiè E, Graziano G, et al. Peripheral neurotoxicity of weekly paclitaxel chemotherapy: a schedule or a dose issue? Clin Breast Cancer. 2007;7(7):550–4.

Kottschade LA, Sloan JA, Mazurczak MA, Johnson DB, Murphy BP, Rowland KM, et al. The use of vitamin E for the prevention of chemotherapy-induced peripheral neuropathy: results of a randomized phase III clinical trial. Support Care Cancer. 2011;19(11):1769–77.

Argyriou AA, Chroni E, Koutras A, Ellul J, Papapetropoulos S, Katsoulas G, et al. Vitamin E for prophylaxis against chemotherapy-induced neuropathy: a randomized controlled trial. Neurology. 2005;64(1):26–31.

Cascinu S, Catalano V, Cordella L, Labianca R, Giordani P, Baldelli AM, et al. Neuroprotective effect of reduced glutathione on oxaliplatin-based chemotherapy in advanced colorectal cancer: a randomized, double-blind, placebo-controlled trial. J Clin Oncol. 2002;20(16):3478–83.

Cascinu S, Cordella L, Del Ferro E, Fronzoni M, Catalano G. Neuroprotective effect of reduced glutathione on cisplatin-based chemotherapy in advanced gastric cancer: a randomized double-blind placebo-controlled trial. J Clin Oncol. 1995;13(1):26–32.

Leal AD, Qin R, Atherton PJ, Haluska P, Behrens RJ, Tiber CH, et al. North Central Cancer Treatment Group/Alliance trial N08CA-the use of glutathione for prevention of paclitaxel/carboplatin-induced peripheral neuropathy: a phase 3 randomized, double-blind, placebo-controlled study. Cancer. 2014;120(12):1890–7.

Knijn N, Tol J, Koopman M, Werter MJ, Imholz AL, Valster FA, et al. The effect of prophylactic calcium and magnesium infusions on the incidence of neurotoxicity and clinical outcome of oxaliplatin-based systemic treatment in advanced colorectal cancer patients. Eur J Cancer. 2011;47(3):369–74.

Gamelin L, Boisdron-Celle M, Delva R, Guérin-Meyer V, Ifrah N, Morel A, et al. Prevention of oxaliplatin-related neurotoxicity by calcium and magnesium infusions: a retrospective study of 161 patients receiving oxaliplatin combined with 5-Fluorouracil and leucovorin for advanced colorectal cancer. Clin Cancer Res. 2004;10(12 Pt 1):4055–61.

Farshchian N, Alavi A, Heydarheydari S, Moradian N. Comparative study of the effects of venlafaxine and duloxetine on chemotherapy-induced peripheral neuropathy. Cancer Chemother Pharmacol. 2018 Nov;82(5):787-793. doi: 10.1007/s00280-018-3664-y. Epub 2018 Aug 13. PMID: 30105459.

Salehifar E, Janbabaei G, Hendouei N, Alipour A, Tabrizi N, Avan R. Comparison of the Efficacy and Safety of Pregabalin and Duloxetine in Taxane-Induced Sensory Neuropathy: A Randomized Controlled Trial. Clin Drug Investig. 2020 Mar;40(3):249-257. doi: 10.1007/s40261-019-00882-6. PMID: 31925721.

Jennaro TS, Fang F, Kidwell KM, Smith EML, Vangipuram K, Burness ML, Griggs JJ, Van Poznak C, Hayes DF, Henry NL, Hertz DL. Vitamin D deficiency increases severity of paclitaxel-induced peripheral neuropathy. Breast Cancer Res Treat. 2020 Apr;180(3):707-714. doi: 10.1007/s10549-020-05584-8. Epub 2020 Mar 12. PMID: 32166478; PMCID: PMC7945004.

Sayfalar

567-574

Gelecek

7 Ağustos 2025

Lisans

Lisans