Akciğer kanserinin tedavisinde periferiknöropati; Önemli bir komorbidite

Yıl 2019, Cilt: 46 Sayı: 3, 505 - 514, 16.09.2019

Şenay Aydın Cengiz Özdemir Suna Aşkın Turan Yusuf Başer Murat Kıyık

https://doi.org/10.5798/dicletip.620534

Öz

Amaç: Klinik pratiğimizde akciğer kanseri tedavisinde uygulanan kemoterapi rejimlerine bağlı gelişen periferiknöropatiler sık gözlenmektedir. Bu çalışmada kemoterapi tedavisi alan ve periferiknöropati gelişen akciğer kanseri tanılı hastalarda klinik semptomlar ve elektrofizyolojik bulguların değerlendirilmesi amaçlandı.

Yöntemler: Ocak 2012- Ocak 2018 tarihleri arasında nöroloji birimine konsülte edilen ve periferiknöropati ön tanısıyla elektromiyografi (EMG) incelemeleri yapılan akciğer kanseri tanılı hastaların demografik verileri, semptomları, nörolojik muayeneleri, EMG bulguları ve tedavilerinde kullanılan kemoterapi ajanları retrospektif olarak gözden geçirildi. Nöropatiye neden olabilecek diyabetesmellitus, üremi, tiroid hastalıkları ve diğer sistemik hastalıklara sahip olan hastalar çalışma dışında bırakıldı.

Bulgular: 371 (315, Erkek) hasta çalışmaya dahil edildi. Hastaların 203’ünde (%54,7) pozitif duyusal, 247’inde (%66,6) negatif duyusal, 81‘inde (%21,8) motor semptomlar ve 127 ’inde (%34,2) ağrı semptomları mevcuttu. EMG ile saptanan polinöropati varlığına göre hastalar polinöropati olanlar Grup I (n:250, %67,4) ve olmayanlar Grup II (n:121, %32,6) olarak sınıflandırıldı. Grup I’ de, 160 hastada (%43,1) duyusal, 5 hastada (%1,3) motor, 85 hastada (%22,9) duyusal ve motor liflerin birlikte etkilendiği polinöropati varlığı saptandı. Grup I’ de negatif duyusal semptomlar ile motor semptomlar, Grup II ‘de dizestezi ve parestezi semptomları istatistiksel anlamlılıkta yüksek oranda gözlendi (p=0.001, p=0.001, p=0.001, p=0.001).

Sonuç: Akciğer kanseri tedavisinde uygulanan kemoterapi rejimlerine bağlı gelişen periferiknöropatilerde en sık duyusal semptomlar gözlenmekte ve kemoterapi ajanına göre motor semptomlarda artış gözlenebilmektedir.

Anahtar Kelimeler

Akciğer kanseri, elektromiyografi, duyusal semptomlar

Kaynakça

• 1. Quasthoff S, Hartung HP. Chemotherapy-induced peripheral neuropathy. J Neurol. 2002; 249: 9-17.
• 2. Han Y, Smith MT. Pathobiology of cancer chemotherapy-induced peripheral neuropathy (CIPN). Front Pharmacol.2013; 18: 4: 156.
• 3. Argyriou AA, Kyritsis AP, Makatsoris T, Kalofonos HP. Chemotherapy-induced peripheral neuropathy in adults: a comprehensive update of the literature. Cancer Manag Res. 2014; 6: 135–47.
• 4. Park SB, Goldstein D, Krishnan AV, et al. Chemotherapy‐induced peripheral neurotoxicity: A critical analysis. CA Cancer J Clin. 2013; 63: 419–37.
• 5. Al-Atiyyat N, Obaid A. Management of peripheral neuropathy induced by chemotherapy in adults with cancer: a review. Int J Palliat Nurs. 2017 Jan 2; 23: 13-7.
• 6. Kerckhove N, Pereira B, Pezet D, Balayssac D. Clinicalassessment of new antineuropathic strategies for chemotherapy-induced peripheral neuropathy: pain should not be the principal endpoint. Pain. 2017; 158: 180–2.
• 7. Cata JP, Weng HR, Burton AW, Villareal H, Giralt S, Dougherty PM. Quantitative sensory findings in patients with bortezomib-induced pain. J Pain. 2007 Apr; 8: 296-306.
• 8. Wilkes G. Peripheral neuropathy related to chemotherapy. Semin Oncol Nurs. 2007 Aug; 23: 162-73.
• 9. Gutierrez-Gutierrez G, Sereno M, Miralles A, Casado-Saenz E, Gutierrez Rivas E. Chemotherapy-induced peripheral neuropathy: clinical features, diagnosis, prevention and treatment strategies. Clin. Transl. Oncol. 2010; 12: 81-91.
• 10. Seretny M, Currie GL, Sena ES, et all. Incidence, prevalence, and predictors of chemotherapyinduced peripheral neuropathy: a systematic review and meta-analysis. Pain. 2014; 155: 2461–70.
• 11. Dougherty PM, Cata JP, Cordella JV, Burton A, Weng HR. Taxol-induced sensory disturbance is characterized by preferential impairment of myelinated fiber function in cancer patients. Pain. 2004 May; 109: 132-42.
• 12. Johnson C, Pankratz VS, Velazquez AI, et all. Candidate pathway-based genetic association study of platinum and platinum-taxane related toxicity in a cohort of primary lung cancer patients. J. Neurol. Sci. 2015; 349: 124–8.
• 13. Paternostro-Sluga T, Grim-Stieger M, Posch M, et all. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med. 2008 Aug; 40: 665-71.
• 14. Krishnan AV, Goldstein D, Friedlander M, Kiernan MC. Oxaliplatin-induced neurotoxicity and the development of neuropathy. Muscle Nerve. 2005; 32: 51–60.
• 15. Rowinsky EK, Chaudhry V, Cornblath DR, Donehower RC. Neurotoxicity of Taxol. J Natl Cancer Inst Monogr. 1993; 15: 107–15.
• 16. Reyes-Gibby CC, Morrow PK, Buzdar A, Shete S. Chemotherapy-induced peripheral neuropathy as a predictor of neuropathic pain in breast cancer patients previously treated with pacliaxel. J Pain 2009; 10: 1146-50.
• 17. Kolb NA, Smith AG, Singleton JR, et all. The Association of Chemotherapy-Induced Peripheral Neuropathy Symptoms and the Risk of Falling. JAMA Neurol. 2016; Jul 1; 73: 860-6.
• 18. Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall? JAMA. 2007; 297: 77-86.
• 19. Strumberg D, Brugge S, Korn MW, et all. Evaluation of long-term toxicity in patients after cisplatinbased chemotherapy for non seminomatous testicular cancer. Ann. Oncol.2002; 13: 229–36.
• 20. Hile ES, Fitzgerald GK, Studenski SA. Persistent mobility disability after neurotoxic chemotherapy. Phys Ther. 2010 Nov; 90: 1649-57.
• 21. Gutiérrez-Gutiérrez G, Sereno M, Miralles A, Casado-Sáenz E, Gutiérrez-Rivas E. Chemotherapy-induced peripheral neuropathy: clinical features, diagnosis, prevention and treatment strategies. Clin Transl Oncol. 2010 Feb; 12: 81-91.
• 22. Fernandes R, Mazzarello S, Hutton B, et all. Taxane acute pain syndrome (TAPS) in patients receiving taxane-based chemotherapy for breast cancer-a systematic review. Support. Care Cancer. 2016; 24: 3633–50.
• 23. Loprinzi CL, Maddocks-Christianson K, Wolf SL, et all. The Paclitaxel acute pain syndrome:sensitization of nociceptors as the putative mechanism. Cancer J. 2007; 13: 399–403.
• 24. Loprinzi CL, Reeves BN, Dakhil SR, et all. Natural history of paclitaxel-associated acute pain syndrome: prospective cohort study NCCTG N08C1. J Clin Oncol. 2011; 29: 1472–8.
• 25. Amptoulach, S., and Tsavaris, N. Neurotoxicity caused by the treatment with platinum analogues. Chemother. Res. Pract. 2011; 2011: 843019.
• 26. Wolf S, Barton D, Kottschade L, Grothey A, Loprinzi C. Chemotherapy-induced peripheral neuropathy: prevention and treatment strategies. Eur J Cancer. 2008; 44: 1507–15.
• 27. Monfort SM, Pan X, Patrick R, et all. Gait, balance, and patient-reported outcomes during taxane-based chemotherapy in early-stage breast cancer patients. Breast Cancer Res Treat. 2017 Jul; 164: 69-77.
• 28. Koike H, Tanaka F, Sobue G. Paraneoplastic neuropathy: wide-ranging clinicopathological manifestations. Curr Opin Neurol. 2011; 24: 504-10.
• 29. Raspotnig M, Vedeler C, Storstein A. Paraneoplastic neurological syndromes in lung cancer patients with or without onconeural antibodies. J Neurol Sci. 2015; 15: 348: 41-5.