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Chemotherapy-Induced Peripheral Neuropathy: a Literature Review Neuropatia Periférica Induzida Por Quimioterapia: Uma Revisão De Literatura

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Chemotherapy-Induced Peripheral Neuropathy: a Literature Review Neuropatia Periférica Induzida Por Quimioterapia: Uma Revisão De Literatura REVIEW Chemotherapy-induced peripheral neuropathy: a literature review Neuropatia periférica induzida por quimioterapia: uma revisão de literatura Lelia Gonçalves Rocha Martin1, Maria Denise Pessoa Silva2 ABSTRACT despite widespread clinical use in oncology, several Peripheral neuropathy is a common side effect in patients undergoing reports are presented in the literature of complaints cancer treatment with chemotherapy. This condition can affect associated with side effects of this treatment(³). One patients in several different ways, interfering in their activities of daily of the side effects is neurotoxicity. In the literature the living and autonomy. The present study aimed to review the literature following drugs used in cancer chemotherapy are listed on chemotherapy-induced peripheral neuropathy and its treatment or as neurotoxic: vincristine, vinblastine, vinorelbine, other possible interventions. The findings reveal that chemotherapy- cisplatin, oxaliplatin, cytarabine, ifosfamide, induced peripheral neuropathy is a common condition that affects 5-fluorouracil, methotrexate, paclitaxel, docetaxel, patients undergoing treatment with some specific drugs. Besides, several different substances have been used to treat or control this altretamine, procarbazine, interleukin-2, fludarabine, (4) condition, although no significant evidence could be found in these cladribine, and pentostatin . studies. Peripheral neuropathy is the involvement of neurons that form the peripheral nerves or nerve Keywords: Peripheral nervous system diseases/chemically induced; roots. This condition causes motor and sensory Drug therapy/adverse effects symptoms, which may include weakness, muscle atrophy and hypotonia, hyporeflexia or areflexia, hypesthesia, paresthesia, dysesthesia, sensory ataxia, RESUMO leading to impaired performance of the individual in A neuropatia periférica é um efeito colateral comum em pacientes daily activities and functional independence. As to its sob tratamento quimioterápico. Essa condição pode se manifestar de etiology, peripheral neuropathy can be associated with diversas maneiras, interferindo na qualidade de vida e na autonomia general medical conditions, infectious or inflammatory nas atividades de vida diária dos pacientes em questão. O presente trabalho teve como objetivo revisar a literatura referente à neuropatia processes, metabolic processes, and heredity. This periférica induzida por quimioterapia, bem como propostas de study addresses the peripheral neuropathy associated tratamento e intervenção para o efeito colateral em questão. Foi with metabolic processes, due to the toxic effect of possível observar que a neuropatia periférica induzida por quimioterapia chemotherapy and its interference in the healthy é uma condição comum a pacientes sob tratamento com alguns metabolism of the nerve cell(5-8). quimioterápicos específicos. Além disso, foi possível identificar, The main symptoms of chemotherapy-induced embora sem evidência significativa, que diversas substâncias vêm peripheral neuropathy (CIPN) may depend on the drug sendo utilizadas como possível tratamento ou paliativo para o efeito and dose used, but usually manifest as predominantly colateral em questão. distal weakness, loss of sensation and reflexes. Descritores: Doenças do sistema nervoso periférico/induzido Discontinuation of the drug which induced peripheral quimicamente; Quimioterapia/efeitos adversos neuropathy appears to suppress the symptoms, however, the remaining signs of toxicity should be observed, taking heed of the presence of permanent injury(7,8). INTRODUCTION It is estimated that 30 to 40% of patients who receive Several studies indicate that chemotherapy is the chemotherapy develop peripheral neuropathy(9-11). There treatment of choice for most cases of cancer(1,2). However, are reports, however, of incidences up to 60% when the 1 Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil. 2 Associação de Assistência à Criança Deficiente – AACD, São Paulo (SP), Brazil. Corresponding author: Lelia Gonçalves Rocha Martin – Avenida Albert Einstein, 627/701– Piso Chinuch – Oncologia ambulatorial de quimioterapia – Morumbi – CEP 05651-901 – São Paulo (SP), Brazil – Tel.: 11 2151-1233 – E-mail: [email protected] Received on: Aug 2, 2011 – Accepted on: Nov 3, 2011 einstein. 2011; 9(4 Pt 1):538-44 Chemotherapy-induced peripheral neuropathy 539 drugs used are cisplatin(12,13), paclitaxel(14), docetaxel(15), From the 26 studies selected, 5 themes were identified vincristine(16), oxaliplatin, and bortezomib(17). (Figure 1). It must be highlighted that in this study only This study focuses on investigating chemotherapy- the results for the treatment of CIPN will be discussed. induced neurotoxicity manifested as peripheral neuropathy. In the literature, there are several studies that investigate the relation among the use of chemotherapy drugs, their neurotoxicity and the presence of neurological diseases, including peripheral neuropathy(18-23). Given the evidence shown in the literature, it is necessary to investigate the incidence, symptoms, and therapeutic procedures associated with CIPN. Thus, cancer care professionals may outline patterns in the disease development, as well as plans for early Figure 1. Main themes intervention and, above all, therapeutic strategies that include support and adaptation in daily activities for this DISCUSSION population, assuring greater independence, autonomy, and quality of life. In presenting the results, we found that most of the publications identified had CIPN treatment as the main theme. There was heterogeneity in the OBJECTIVES substances and techniques used in the treatment - To identify studies in the literature addressing CIPN. of CIPN. Thus, the following techniques and - To identify plans in the literature for prevention and substances identified in the articles of this review treatment of CIPN. are presented. Radiofrequency ablation METHODS An Indian study published a case study of a 63 year- This study was a descriptive, exploratory narrative old male patient diagnosed with prostate cancer review of the literature. Guiding questions: “How to with bone metastases in acetabulum, left ischium, characterize CIPN? Are there prevention and treatment femoral head, vertebrae, ribs, pelvis, and skull. for this condition?” The patient underwent surgery and subsequent Selected databases during the second half of 2010: radiotherapy and adjuvant chemotherapy with Scientific Electronic Library Online (SciELO), Latin docetaxel and prednisone. Three months after American and Caribbean Literature on Health Sciences surgery and the end of the chemotherapy cycles, (LILACS), Pubmed, Cumulative Index to Nursing the patient started to have pain and tingling in and Allied Health Literature (CINAHL), and Web of the right palm, followed by numbness in the arm, Science. Scientific studies in Portuguese, English, and forearm, and right palm. The report indicates that Spanish published from September 2005 to September the patient was refractory to CIPN treatments that 2010 were included. included gabapentin, pregabalin, and morphine. Keywords researched: “treatment” and After excluding the differential diagnosis of carpal “chemotherapy-induced peripheral neuropathy”. tunnel syndrome, radiofrequency treatment was The cataloging of contents from the publications initiated. The continued radiofrequency stimulation included in the data collection was performed according occurred in two cycles of 90 seconds in the ulnar and to a semi-structured routine (Chart 1). median nerves. After 2 to 4 hours of stimulation, the The data were cataloged and the relevant topics patient reported improvement of symptoms. The addressed in the studies generated thematic categories, next day the patient reported a 40% decrease in the which were discussed in the results and discussion of pain, and 2 days later, an improvement of 90%, and this study. the use of morphine and other pain medications was discontinued. We observed that this study addressed the technique of ablation by continued RESULTS radiofrequency energy as an alternative treatment A total of 57 studies were identified, and 26 of them met for the management of CIPN pain. However, there the inclusion criteria established. were no reports of decrease in sensory and motor einstein. 2011; 9(4 Pt 1):538-44 540 Martin LGR, Silva MDP Chart 1. Characterization of selected studies N Database Title Authors Year Origin Type of study Main themes 1 PUBMED Persistent mobility disability after Hile ES, Fitzgerald GK, 2010 United States Case Study Clinical manifestations neurotoxic chemotherapy Studenski SA 2 PUBMED BNP7787-mediated modulation of Parker AR, Petluru PN, Wu M, 2010 United States Review Pathophysiology paclitaxel- and cisplatin-induced Zhao M, Kochat H, Hausheer aberrant microtubule protein FH polymerization in vitro 3 PUBMED Glutamate carboxypeptidase inhibition Carozzi VA, Chiorazzi A, Canta 2010 Italy Experimental Treatment reduces the severity of chemotherapy- A, Lapidus RG, Slusher BS, induced peripheral neurotoxicity in rat Wozniak KM, Cavaletti G 4 CINAHL Radio frequency ablation in drug Yadav N, Philip FA, Gogia 2010 India Review Treatment resistant chemotherapy-induced V, Choudhary P, Rana SPS, peripheral neuropathy: a case report Mishra S, Bhatnagar B and review of literature 5 PUBMED Patient perceptions associated with Tofthagen C 2010 United States Clinical trial Clinical manifestations chemotherapy-induced peripheral neuropathy 6 WEB OF Neurophysiological,
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