Persistent neuropathy after treatment with cisplatin and oxaliplatin

Figures & data

Figure 1.  Flowchart for patient inclusion

Table I.  Questionnaire items

Hands/arms	Feet/legs	Orofacial
Numbness/tingling	Numbness/tingling	Numbness/tingling
Oversensitivity	Oversensitivity	Disturbances in recognition of
Burning pain	Burning pain	objects
Difficulty handling/feeling	Instability
Objects	L'hermitte's sign
L'hermitte's sign
Disturbances in recognition of hot/cold/rough/smooth

Table II.  Characteristics of participants

	Cisplatin	Oxaliplatin
Gender (m/f)	13 m/7 f	20 m/5 f
Age at time of chemotherapy	22–66 years (median 43)	40–73 years (median 62)
Age at time of follow-up	25–68 years (median 49)	41–76 years (median 64)
Duration of follow-up	18–75 months (median 41)	8–33 months (median 18)
Tumour type	Testicular carcinoma (9)	Colorectal carcinoma (25)
	Yolk sac carcinoma (1)
	Non small cell lung cancer (1)
	Small cell lung cancer (1)
	Head and neck carcinoma (8)
Cumulative dose	300–600 mg/m^2 cisplatin	585–1170 mg/m^2 oxaliplatin
	(median 350)	(median 878)
	195–390 mg/m^2 Pt	287–575 mg/m^2 Pt
	(median 227)	(median 431)
Sodium thiosulfate	5 head and neck carcinoma patients treated intra-arterially with 600 mg/m^2 cisplatin	NA
Ca/Mg infusion	NA	24/25
GSTM1	8/20 positive, 12/20 negative	10/25 positive, 15/25 negative
GSTT1	17/20 wildtype, 3/20 negative	21/25 positive, 4/25 negative
GSTP1	12/20 ^105Ile/^105Ile-GSTP1	9/25 ^105Ile/^105Ile-GSTP1
	7/20 ^105Val/^105Ile-GSTP1	10/25 ^105Val/^105Ile-GSTP1
	1/20 ^105Val/^105Val-GSTP1	6/25 ^105Val/^105Val-GSTP1
Plasma Pt levels	142–1.15×10^3 ng/L	460–2.99×10^3 ng/L
GFR at time of chemotherapy	51.4–89.5 mL/min/1.73m^2	36.5–74.1 mL/min/1.73m^2
	(median 77.6)	(median 55)
GFR at time of follow-up	26.7–142 mL/min/1.73m^2	33.6–79.6 mL/min/1.73m^2
	(median 64.8)	(median 61.2)

NA = not applicable

Figure 2.  Hands and feet VT values for cisplatin (▵) and oxaliplatin (○) treated patients and the mean values (♦) (+2 SD (▪)) for 110 control patients [23] plotted against the age

Table IIIa.  Sensitivity and specificity for a VT-cut-off value of 2 SD

	Questionnaire
VT test	Hands (2 SD)	Present	Absent	Feet (2 SD)	Present	Absent
	Present	10	5	Present	16	2
	Absent	16	14	Absent	16	10
	Total	26	19	Total	32	12

Hands  sensitivity: 38%,  specificity: 74%

Feet  sensitivity: 50%,  specificity: 83%

Table IIIb.  Sensitivity and specificity for VT-cut-off values of 1.4 (hands) and 1.7 (feet) SD

	Questionnaire
VT test	Hands (1.4 SD)	Present	Absent	Feet (1.7 SD)	Present	Absent
	Present	20	7	Present	23	2
	Absent	6	12	Absent	9	10
	Total	26	19	Total	32	12

Hands  sensitivity: 77%,  specificity: 63%

Feet  sensitivity: 72%,  specificity: 83%

Figure 3.  Questionnaire sum-scores for the hands and feet for cisplatin patients without neuropathy (▵), cisplatin patients with neuropathy (▴), oxaliplatin patients without neuropathy (□), and oxaliplatin patients with neuropathy (▪)

Figure 4a.  Questionnaire sum-scores for the feet versus Sensitized Romberg Test (0 = normal balance, 1 = abnormal balance) and Tandem Gait scores (0 = normal stability, 1 = difficulty to remain stable, 2 = tendency to fall)

Figure 4b.  Feet ln VT values versus Sensitized Romberg Test (0 = normal balance, 1 = abnormal balance) and Tandem Gait scores (0 = normal stability, 1 = difficulty to remain stable, 2 = tendency to fall)

Figure 5a.  Ln VT values for the hands for cisplatin (▴) and oxaliplatin (▪) treated patients versus time and a median patients treated with 300 mg/m² cisplatin (––––), with 600 mg/m² cisplatin combined with STS (-----), and with oxaliplatin 878 mg/m² (-------)

Figure 5b.  Ln VT values for the feet for cisplatin (▵) and oxaliplatin (□) treated patients versus time and a median patients treated with 300 mg/m² cisplatin (–––), with 600 mg/m² cisplatin combined with STS (-----), and with oxaliplatin 878 mg/m² (-------)

Chong PS, Cros DP. Technology literature review: Quantitative sensory testing. Muscle Nerve 2004; 29: 734–47

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