Carcinoma associated peripheral neuropathy (PN): Our experience

Abstract

20540 Background: PN occurs in almost 10% of cancer patients(pts). Tumours associated are lung, breast, gynaecological cancers, and lymphoma. The clinical findings are heterogeneous and the pathogenesis is unknown. Its incidence is high(up to 50%) in pts undergoing electrodiagnostic evaluation. The aim of the study was to asses the incidence of clinical PN in untreated newly diagnosed cancer pts. Methods: Longitudinal and prospective study. Pts with recent diagnosis of cancer without oncological treatment and PN were included. Ineligibility criteria included alcoholism, renal failure, hypothyroidism, diabetes mellitus, immunological illness, previous PN and nutritional deficiency. Neurological examination (NE) by a trained oncologist and a neurologist was performed to detect PN. We evaluated objective and subjective superficial sensibility; deep sensibility; muscle strength (Medical Research Council Scale, muscle atrophy); deep tendon reflexes; autonomic function. Following that, a nerve conduction study (NCS) and an electromyography (EMG) in the upper and lower limbs were performed. Results: From March/December 2006, 39 pts were enrolled. Pts characteristics included: median age: 58,6 (range 24–82), male/female: 24/15, Performance Status 0/1: 26/13. All pts have been evaluated with NE and 28 of them with NCS-EMG. NE revealed some kind of abnormality in 10 pts (25,64%). In this group: 100% showed disorders in deep sensibility; 30% autonomic dysfunction; 20% abnormalities in superficial sensibility; 20% hyporreflexia in the lower extremities;10% moderate weakness in lower limb muscles. 10pts showed clinical evidence of peripheral nerve dysfunction and 2 of them were confirmed by NCS-EMG as axonal neuropathy. Conclusions: In our cancer pts sample, a high incidence of clinical PN was observed. Abnormalities in deep sensibility were the most frequently observed disorder. Distal symmetrical sensorimotor neuropathy was the most frequent presentation. Electrophysiological studies characterize this disorder as a distal axonopathy. We concluded that it should be important to consider the diagnosis of PN in any pt with cancer and an unexplained neurological dysfunction. No significant financial relationships to disclose.