O3.07QUICK NON INVASIVE AND QUANTITATIVE EVALUATION OF SMALL FIBER NEUROPATHY IN PATIENTS RECEIVING CHEMOTHERAPY

摘要

Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common, potentially severe and dose-limiting adverse effect of cancer treatment however it is poorly investigated at the early stage due to the lack of simple tool. SUDOSCAN is a quick, non-invasive and quantitative method to assess sudomotor function, based on an electrochemical reaction between sweat chloride and stainless-steel electrodes. It has been validated in small C-Fibers function assessment in diabetes and amylosis. This study aimed to evaluate SUDOSCAN in the detection and follow-up of CIPN in patients treated with neurotoxic chemotherapy even before occurrence of symptoms. 16 patients receiving Oxaliplatin (12 males, mean age: 60 ± 9 years), 8 Carboplatin (4 males, mean age: 67 ± 12 years) and 15 Paclitaxel (5 males, mean age: 64 ± 15 years) were involved in the study. At each chemotherapy infusion accumulated dose of chemotherapy was calculated and the Total Neuropathy Score (TNSc) was performed. To measure small fibre neuropathy patients were assessed by SUDOSCAN (3 minutes exam). The device measures the Electrochemical Sweat Conductance (ESC) of the hands and feet expressed in microSiemens (µS). For patients receiving Oxaliplatin (initial mean cumulated dose (MCD): 282 ± 250 mg/m² and last MCD: 475 ± 238 mg/m²) hands ESC changed from 74 ± 9 to 71 ± 10 and feet ESC from 78 ± 13 to 77 ± 17 µS while TNSc changed from 3 ± 4 to 4 ± 3. In patients receiving Carboplatin (initial MCD: 1296 ± 1304 mg/m² and last MCD: 1885 ± 1426 mg/m²) hands ESC changed from 57 ± 14 to 46 ± 12 µS and feet ESC from 58 ± 15 to 49 ± 19 µS while TNSc changed from 5 ± 3 to 6 ± 4. In patients receiving Paclitaxel (initial MCD: 1254 ± 1220 mg/m² and last MCD: 1613 ± 1325 mg/m²) hands ESC changed from 62 ± 18 to 50 ± 20 µS and feet ESC from 72 ± 16 µS to 67 ± 19 µS while TNSc changed from 6 ± 2 to 7 ± 3. For patients receiving Carboplatin which MCD was inferior to Median Cumulated Dose (MeCD) (n = 4), hands ESC changed from 57 ± 9 to 37 ± 6 µS while patients receiving paclitaxel which MCD was inferior to MeCD (n = 7) hands ESC changed from 67 ± 14 to 48 ± 13 µS. When looking at asymptomatic patients mean TNSc was of 2± 2 at initial visit, and 3 ± 2 at last visit. Mean hands ESC changed from 63 ± 21 µS to 52 ± 23 µS, while mean feet ESC changed from 67 ± 22 µS to 63 ± 22 µS at last measure, suggesting that SUDOSCAN could help detecting and quantifying CIPN even in asymptomatic patients. This preliminary study evidenced that small fibre neuropathy can be followed using SUDOSCAN in patients receiving chemotherapy. These preliminary results observed in an on-going chemotherapy must be confirmed in a larger population with measurements performed before the initiation of chemotherapy and during its follow-up.