Survivorship and Patients Perspective
L. Smardova1, E. Vlckova2, A. Rajdova2, J. Raputova2, J. Bednarik2, Z. Kral1
1Department of Hematology and Oncology, Masaryk University and University Hospital Brno, Czech Republic,2Department of Neurology, Masaryk University and University Hospital Brno, Czech Republic
Background: Chemotherapy-induced peripheral neuropathy (CIPN) represents one of the most worrisome and common long-term adverse effects of chemotherapy treatment of cancer. In patients treated with vinca-alkaloids (V-A), the clinical manifestation is mainly sensory and may affect predominantly small sensory fibers. The aim was to assess the incidence of CIPN in patients treated with V-A and compare treatment regimens and the diagnostic validity of several tests and methods.
Methods: A group of 26 patients (18 men, 8 women, median age 36) with Hodgkin lymphoma (HL) underwent detailed clinical neurological examination, pain status, routine electromyography/nerve conduction studies (EMG/NCS) and comprehensive quantitative sensory testing protocole (QST) before and 6 months after the end of the administration of anti-cancer V-A chemotherapy (BEACOPP, “”2+2”” regimens).
Results: At the follow-up examination, fourteen patients (54%) reported some sensory symptoms and/or neuropathic pain in lower (11 cases) and/or upper (8 cases) extremities. There was an unsignificant trend to higher incidence of clinical symptoms in patients treated with vincristine (60%) comparing to those treated with the combination of vinblastine and vincristine (33%) (p = 0.25, not significant probably due to low numbers of patients in both the subgroups). The symptoms were usually of mild to moderate intensity. In upper extremities, the symptoms -mostly corresponded with clinically symptomatic carpal tunnel syndrome. The EMG/NCS examination confirmed polyneuropathy in 13 patients (50%) (8 symptomatic, 5 asymptomatic), while clinical examination displayed only minor abnormities in two of the symptomatic individuals. Twenty-two patients (84%) displayed at least one new QST abnormity in feet (and 9 in hands), most frequently in thermal sensation and thermal pain modalities. Some abnormities relevant to peripheral nerve dysfunction in any of the methods used in this study were found in 88% of HL patients treated with V-A.
Conclusions: Symptoms of CIPN persist at least 6 months after the end of V-A chemotherapy in about 54% of HL patients. Clinical neurological examination is the least sensitive method used for confirmation of peripheral neuropathy in these patients, while both the EMG/NCS and QST reveal neuropathy more frequently. Some abnormities of peripheral nerve function can be found even in asymptomatic individuals.