The characterization of oxaliplatin-induced peripheral neuropathy using electromyography in gastrointestinal cancer patients

Oxaliplatin-induced peripheral neuropathy (OIPN) is a common dose-dependent chemotherapy complication in gastrointestinal cancer (GIC). This side effect may restrict therapeutic dose elevation of oxaliplatin. Here, OIPN frequency and determinants of neuropathy appearance in oxaliplatin-treated GIC patients. A total of ۱۰۲ GIC patients who underwent chemotherapy with fluorouracil, folinic acid and oxaliplatin (FOLFOX۴) regimen participated in this longitudinal study. Electromyography (EMG) was accomplished for ulnar, radial, sural, peroneal nerves and superficial peroneal nerve (SPN) before, ۳, and ۶ months after treatment. National Cancer Institute-Common Toxicity Criteria V.۳ and clinical version of the Total Neuropathy Score were used for the neuropathy diagnosis at six months after treatment onset. Of all entered patients, twelve people discontinued this study, and five patients passed away. About ۸۵ patients remained three and six months after chemotherapy onset. Approximately ۹۵% of patients three months after chemotherapy demonstrated OIPN manifestations. Finally, data for ۸۱ patients having neuropathy were analyzed. Mean age of patient ۶۴.۰±۱۰.۹ years. There were about ۳.۷%, ۳۰.۹%, ۶۳% grade III, II, I of neuropathy, respectively. Interestingly, a significant decrease in action potential (AP) amplitude of SPN, sural and radial nerves but not ulnar and peroneal was observed after treatment onset. However, only the ulnar nerve indicated a substantial deceleration of nerve conduction. Age, sex, weight, past medical diseases, smoking and acute neuropathy were not significantly associated with OIPN. The occurrence of OIPN is detectable by electrophysiological changes of SPN, radial, and sural nerves at three and six months after starting chemotherapy with the FOLFOX۴ regimen.

Keywords:

Oxaliplatin , Neuropathy , Gastrointestinal cancer , Chemotherapy , Electromyography