NEUROLOGICAL MONITORING OF NEUROTOXICITY INDUCED BY PACLITAXEL CISPLATIN CHEMOTHERAPY/

To evaluate the neurotoxicity of paclitaxel/cisplatin chemotherapy, we studied neurological and electrophysiological functions in 14 patient s who had been treated with 1-7 courses of paclitaxel/cisplatin. The c umulative paclitaxel and cisplatin doses ranged from 175 to 1225 mg/m( 2) and 100-700 mg/m(2), respectively. Neurological examinations as wel l as motor nerve conduction studies of the peroneal nerve were perform ed and summarised by means of a peripheral neuropathy score. Neurotoxi city with onset usually after the second treatment cycle occurred in 1 3 patients. 12 patients complained about sensory symptoms, 13 patients had impaired vibration sense and 8 patients developed additional musc le weakness, predominantly of the legs. Dysfunction of peroneal motor nerve conduction occurred in 13 patients. Reduction of amplitudes as w ell as slowing of conduction velocities were seen in 13 patients and p rolonged distal latencies in 10 patients. The peripheral neuropathy sc ore was elevated in 13 patients. Neurological symptoms, impairment of both vibration sense and tendon reflexes, and the peripheral neuropath y score increased with the cumulative doses of paclitaxel/cisplatin. S erial analysis among selected patients also revealed an increase in ne urotoxicity with increasing cumulative drug doses. These data indicate the development of neurotoxicity in most patients treated with paclit axel/cisplatin and also suggest that early signs of neurotoxicity can be detected by clinical examination with emphasis on symptoms as well as vibration sense and can be well documented by electrophysiological investigations. (C) 1997 Elsevier Science Ltd.