Clinical Study Of Chemotherapy Induced Peripheral Neuropathy And Serum Level Of IL-1β,GAP-43,GDNF Changes With The Cumulative Dosage Of Oxaliplatin In Patients With Oxaliplatin Therapy

Objective:To analyze the clinical manifestation and the electrophysiological features of chemotherapy-induced peripheral neuropathy (CIPN) in the patients using any kind of the anti-neoplastic agents which had neurotoxicity. The relationship between the cumulative dosage of the responsible drug and the severity of the peripheral neurotoxicity was also detected.Method:Patients in the Department of Clinical Oncology of Zhong Shan Hospital from Mar.2009 to Feb.2010 who met the criteria for CIPN were collected. The criteria are:1.The patient should be conscious at the base line,2.The patient's liver and kidney function were both normal,3.The toxicity severity of the responsible drug should be≥GradeⅡby the standard of neuropathy induced by chemotherapy of National Cancer Institute(NCI),4.The sensory or motor symptoms and sign of the patient should be associated with his/her chemotherapy,5.Any other cause such as diabetes mellitus, alcoholism, cervical spondylosis, auto-immunoneuropathy should be excluded,6. The informed consent should be signed by the patient or his/her relatives. The clinical manifestations, Michigan Neuropathy Screening Instrument (MNSI), Michigan Diabetic Neuropathy Score (MDNS), FACT/GOG-NTX, Brief Pain Instrument (BPI) and nerve conductive study were all used to detect the severity and distribution of CIPN in every patient. Since the Oxaliplatin was the commonest used drug in our study, the relationship between the mean cumulative dosage of this drug and the severity of CIPN was studied.Results:Totally ninety-five patients of CIPN were included in this research. The main clinical manifestations of the patients were burning pain and numbness of the extremities. When examined, the pin prick sensation, tactile sensation and/or vibratory sensation of the affected extremities were decreased or absent, tendon reflexes and muscle strength in the lower limbs in some patients were also decreased and some of them had kinds of foot deformity.69 patients (82.14%) showed abnormal electrophysiological feature.As with the correspond drug,68 patients used Oxaliplatin, the mean cumulative dosage was 1176.91mg±370.42mg/m2,8 with vincristine, the mean cumulative dosage was 5.14mg±1.07mg/m2,5 with paclitaxel, the mean cumulative dosage was 640mg±245.36mg/m2,3 with cisplatin, the mean cumulative dosage was 360mg±120mg/m2. The MNSI, MDNS score have positive linear relevance with cumulative dosage of Oxaliplatin.Conclusion:CIPN could be induced by Oxaliplatin, vincristine, paclitaxel and cisplatin. The clinical manifestations, electrophysiological feature are related to specific chemotherapy drugs and their cumulative dosage. Objective:To evaluate the serum level of interleukin-1β(IL-1β),neuronal growth associated protein-43(GAP-43)and glial cell line-derived neurotrophic factor(GDNF) in patients who were treated with the Oxaliplatin. The relationship between cumulative dosage of this drug and the occurrence of CIPN was also detected.Method:Patients met the following criteria were collected. The criteria are:1. The patient should be conscious at the base line,2.The patient's liver and kidney function were both normal,3.Have not received chemotherapy before,4.No history of peripheral neuropathy and abnormal electrophysiological feature,5.The informed consent should be signed by the patient or his/her relatives.The MNSI, MDNS, FACT/GOG-NTX,BPI and serum level of IL-1β,GAP-43,GDNF were detected in the following 3 periods:at baseline, in the half-course and at the end of Oxaliplatin therapy. Nerve conductive study was given in the following 2 periods:at baseline and at the end of Oxaliplatin therapy. Patients were grouped as EMG abnormal and EMG normal according to the electrophysiology study at the end of chemotherapy.Results:The serum level of IL-1β, GAP-43,GDNF of the patient were decreased with the cumulation of Oxaliplatin dosage.The IL-1βwas higher in the EMG abnormal group than that in the EMG normal group.Conclusion:Among patients with gastric and colorectal cancer who use Oxaliplatin, those who have higher level of IL-1βare prone to having abnormal electroneurophysiological changes.