Assessment of chemotherapy-induced peripheral neuropathy using the LDIFLARE technique: a novel technique to detect neural small fiber dysfunction.

Publisher: John Wiley & Sons Country of Publication: United States NLM ID: 101570837 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2162-3279 (Electronic) NLM ISO Abbreviation: Brain Behav Subsets: MEDLINE

Original Publication: Hoboken, NJ : John Wiley & Sons

Neurologic Examination*; Antineoplastic Combined Chemotherapy Protocols/*adverse effects ; Peripheral Nervous System Diseases/*chemically induced ; Peripheral Nervous System Diseases/*diagnosis ; Platinum Compounds/*adverse effects ; Taxoids/*adverse effects; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Blood Pressure ; Body Mass Index ; Female ; Foot/physiopathology ; Hot Temperature ; Humans ; Lasers ; Male ; Middle Aged ; Peripheral Nervous System Diseases/physiopathology ; Platinum Compounds/therapeutic use ; Severity of Illness Index ; Skin Physiological Phenomena ; Taxoids/therapeutic use ; Vasodilation/physiology

Introduction: The diagnosis and quantification of chemotherapy-induced peripheral neuropathy (CIPN) remains a challenge. Conventional methods including quantitative sensory testing (QST), nerve conduction tests, and biopsy are unable to detect subclinical changes, and do not consistently correlate with severity of patients' symptoms and functional impairment. This study aims to determine the utility of the LDI (laser Doppler imager) FLARE technique in the diagnosis of CIPN and whether it correlates with symptom severity.
Materials and Methods: We assessed 24 patients with established CIPN [12 due to platinum analogs (PA) and 12 to Taxanes (TX)] and 24 matched healthy controls (HC). All underwent neurophysiological examination including vibration perception threshold (VPT), sural nerve amplitude (SNAP) and conduction velocity (SNCV), LDIFLARE, and fasting biochemistry. The QLQ-CIPN20 questionnaire was used to assess symptom severity.
Results: HC, combined chemotherapy (CG), PA , and TX groups were matched for age, sex, BMI, and blood pressure. The LDIFLARE was significantly reduced in CG compared to HC (P =< 0.0001), whereas SNAP (P = 0.058) and SNCV (P = 0.054) were not. The LDIFLARE correlated with the QLQ-CIPN20 symptom scores in all three categories namely, CG (P =< 0.0001), PA (P = 0.001) and TX (P = 0.027) whilst, VPT, SNAP, and SNCV did not.
Conclusion: Our findings suggest that the LDIFLARE technique is more helpful in confirming the diagnosis of CIPN in patients with distal sensory symptoms than current commonly used methods. Moreover, this novel test fulfils the unmet need for a diagnostic test that relates to the severity of symptoms. This may be useful in quantifying early changes in small fibre function indicating early CIPN.

Ann Oncol. 2000 May;11(5):509-13. (PMID: 10907941)
Neurology. 2003 Mar 25;60(6):898-904. (PMID: 12654951)
Semin Radiat Oncol. 2003 Jul;13(3):176-81. (PMID: 12903007)
Cancer. 1981 Jan 1;47(1):207-14. (PMID: 7459811)
Cancer Invest. 1990;8(2):147-59. (PMID: 2400936)
J Neurooncol. 1997 Oct;35(1):47-53. (PMID: 9266440)
Eur J Cancer. 1997 Aug;33(9):1393-9. (PMID: 9337680)
Ann Oncol. 1998 Jul;9(7):739-44. (PMID: 9739440)
Support Care Cancer. 1999 Sep;7(5):354-61. (PMID: 10483822)
Diabetes Care. 2004 Dec;27(12):2930-5. (PMID: 15562209)
Eur J Cancer. 2005 May;41(8):1135-9. (PMID: 15911236)
Curr Opin Neurol. 2005 Oct;18(5):591-7. (PMID: 16155446)
Semin Oncol. 2006 Feb;33(1):15-49. (PMID: 16473643)
Diabetes Care. 2006 Sep;29(9):2023-7. (PMID: 16936147)
J Clin Oncol. 2006 Sep 20;24(27):4507-14. (PMID: 16940275)
Curr Opin Endocrinol Diabetes Obes. 2007 Apr;14(2):141-5. (PMID: 17940432)
Curr Opin Neurol. 2007 Dec;20(6):719-25. (PMID: 17992096)
Diabetes Care. 2008 Mar;31(3):522-4. (PMID: 18070992)
J Peripher Nerv Syst. 2008 Mar;13(1):27-46. (PMID: 18346229)
Front Biosci. 2008;13:3506-24. (PMID: 18508452)
Clin Cancer Res. 2008 Jul 15;14(14):4543-9. (PMID: 18628469)
Diabetes Care. 2009 Mar;32(3):451-5. (PMID: 19074993)
Br J Haematol. 2009 Apr;145(1):3-14. (PMID: 19170681)
Lancet Oncol. 2009 Jun;10(6):539-40. (PMID: 19482244)
Diabetes Care. 2010 Jan;33(1):174-6. (PMID: 20040675)
Eur J Cancer. 2010 Feb;46(3):479-94. (PMID: 20045310)
Diabetologia. 2012 Mar;55(3):795-800. (PMID: 22193513)
Support Care Cancer. 2012 Mar;20(3):625-32. (PMID: 21479990)
Muscle Nerve. 2013 Mar;47(3):351-6. (PMID: 23169592)
PLoS One. 2013;8(7):e69920. (PMID: 23936119)
Qual Life Res. 2013 Dec;22(10):2787-99. (PMID: 23543373)
PLoS One. 2014;9(1):e86515. (PMID: 24466129)
J Diabetes Sci Technol. 2015 Jan;9(1):123-31. (PMID: 25231114)

Keywords: CIPN; EORTC; LDIFLARE; QLQ-CIPN20; nerve conduction velocity and amplitude

0 (Platinum Compounds)
0 (Taxoids)

Date Created: 20150730 Date Completed: 20160412 Latest Revision: 20181113

20250114

PMC4511290

10.1002/brb3.354

26221574