Kemoterapi İlişkili Periferik Nöropati ve Tedavisi

Kemoterapi ilişkili periferik nöropati, nörotoksik kemoterapik ajanlarla oluşan, distal, simetrik, duyusal komponenti baskın ağrı, uyuşma, karıncalanmayla giden bir sendromdur. Hastalarda tekrarlayan dozlarla şiddeti artabilmekte, hastanın yaşam kalitesini bozmasının yanı sıra, kemoterapi dozunda azalma ve tedavi protokolünde değişiklik gerektirmekte ve sağkalımı etkilemektedir. Nörotoksisite de, başta mitokondriyal disfonksiyon ve oksidatif stres olmak üzere çeşitli mekanizmalar aracılığıyla kalın lif ve ince lif nöropatisine neden olmaktadır. Sıklıkla taksan grubu, platin grubu, vinka alkaloidleri, bortezomib ve brentiksumab kullanan hastalarda el ve ayaklarda doz ilişkili nöropatik ağrı izlenir. Tedavide kullanılan antikonvülsan ve antidepresanların etkileri oldukça sınırlıdır. Bu derlemede kemoterapi ilişkili periferik nöropati konusunda farkındalık sağlamak amaçlanmakta, önlenmesi ve tedavisi ele alınmaktadır.

Chemotherapy-Induced Peripheral Neuropathy and Treatment

Chemotherapy induced peripheral neuropathy is a syndrome with distal symmetrical sensorial-dominant pain, tingling and numbness caused by neurotoxic chemotherapeutic agents. The severity increases with cumulative doses of chemotherapy, besides decrease in quality of life, may lead to cessation of treatment which may effect survival. Neurotoxicity causes large fiber and small fiber neuropathy through many pathologic mechanisms including mitochondrial dysfunction and oxidative stress. Dose related neuropathic pain is most commonly seen with taxanes, platins, vinca alkaloids, bortezomib and brentuximab. There is a limited effect of anticonvulsant and antidepressant medication for treatment. In this review awareness about chemotherapy induced peripheral neuropathy, prevention and treatment are discussed.

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