A Quantitative Sensory Analysis of Peripheral Neuropathy in Colorectal Cancer and Its Exacerbation by Oxaliplatin Chemotherapy

Abstract

The goal in this study was to determine the impact of colorectal cancer and cumulative chemotherapeutic dose on sensory function to gain mechanistic insight to the subtypes of primary afferent fibers damaged by chemotherapy. Patients with colorectal cancer underwent quantitative sensory testing (QST) before and then prior to each cycle of oxaliplatin. These data were compared to that from age- and sex-matched healthy volunteers. The patients showed significant subclinical deficits in sensory function prior to any therapy compared to healthy volunteers. Sensory deficits became more pronounced in patients with chemotherapy. Sensory deficits were most pronounced for modalities mediated by large Aβ myelinated fibers and unmyelinated C fibers whereas those modalities of sensation conveyed by thinly myelinated Aδ fibers appeared showed less sensitivity to chemotherapy. Patients with baseline sensory deficits went on to develop more symptom complaints during chemotherapy than those who had no baseline deficit. Patients who were re-tested 6 to 12 months following chemotherapy showed the most numbness and pain as well as the most pronounced sensory deficits. The pattern of effects on sensory function has clear mechanistic implications for the fibers types that are vulnerable to the toxicity of chemotherapy.

Chemotherapy-induced pain and neuropathy

“…Furthermore, although CIPN is often seen as 1 entity, there are important differences between the 2 types of treatment. Although the study supported previous findings of a gradual development of a lengthdependent sensory large-fiber polyneuropathy with tingling and numbness in the feet (L. Ventzel et al unpublished), 8 the development of neuropathic symptoms during chemotherapy was very different in both groups, with a high frequency of patients with cold allodynia in the oxaliplatin group, whereas this symptom was almost nonexisting in the docetaxel group. Neuropathic symptoms were in general more common during oxaliplatin treatment compared with docetaxel treatment.…”

Prechemotherapy Touch Sensation Deficits Predict Oxaliplatin-Induced Neuropathy in Patients with Colorectal Cancer

“…A previous study reported on the use of objective QST assessment of motor-nerve excitability to establish CIPN status [35], and preexisting neuropathy was shown to be a risk indicator for possible high symptom burden for patients receiving oxaliplatin treatment [17;22]. In concert with those results, the current study demonstrates the predictive value of critical components of QST when sensory deficits exist before chemotherapy for identifying individuals with higher risk for self-reported CIPN symptom burden.…”

Chemotherapy-induced peripheral neuropathy after neoadjuvant or adjuvant treatment of breast cancer: a prospective cohort study

“…However, this is the largest hospital providing care to oncological patients in the north of Portugal, treating patients from a wide geographical area, which may help to mitigate the latter limitation. Previous studies have shown that subclinical deficits in sensory function may be present among patients with colorectal cancer [38,39] and myeloma [40,41] even before initiating any therapy, and CIPN may correspond to an exacerbation of this preexisting condition. In our study, although all patients underwent a neurological examination before breast cancer treatment, to exclude clinical neuropathy, we did not perform quantitative sensory testing, and therefore, we cannot exclude the presence of subclinical deficits in sensory function before treatments.…”